The aim of this study was to compare the operation time required and the clinical outcome 2years postoperatively, after anatomic double-bundle ACL reconstructions using hamstring tendon grafts fixed with either the EndoButton-CL-BTB(®) (ECL-BTB) or the EndoButton-CL(®) (ECL). Forty-six patients, who underwent anatomic double-bundle ACL reconstruction, were non-randomly divided into 2 groups. Patients with a combined ligament injury or complete meniscal tear were excluded from this study. In group I, an ECL was used with 23 patients. In group II, an ECL-BTB was used with the remaining 23 patients. In groups I and II, the ECL or ECL-BTB was attached to the femoral ends of the hamstring tendon autografts. In both groups, a polyester tape was connected in series with the tibial ends of the grafts. The patients were examined with standard clinical evaluations at 2years after surgery. The operation time in group II was significantly shorter than that in group I (P=0.0459). Concerning the intra- and postoperative complications, there were no serious complications in either group. No significant differences were found between the 2 groups in terms of knee laxity measurements, the peak muscle torque of quadriceps and hamstrings, the Lysholm score and the IKDC evaluation. This study demonstrated that the usage of the ECL-BTB for graft preparation significantly shortens the total operation time in comparison with the ECL and that there were no significant differences in the 2-year clinical outcome and the intra- and postoperative complications between the 2 graft preparation procedures of the anatomic double-bundle ACL reconstruction. The ECL-BTB can be an alternative device for the hamstring tendon graft in double-bundle ACL reconstruction. Prospective comparative cohort study, Level II.