Anterior cruciate ligament (ACL) injury is a common injury among sport men. Currently the arthroscopic reconstruction is the gold standard treatment in majority of cases. There are different ways to do the surgery, different approaches and different grafts. Each has its advantages and draw backs. The autologous four strands hamstring graft is a widely used graft. A new method of using six strands graft is now used to strengthen the graft. This study is to compare the clinical outcomes of the patients underwent a six strand autologous hamstring graft ACL reconstruction and those done with four strands graft. It`s retrospective and prospective comparative study carried out in Basrah Teaching Hospital. Started at January 2015. Twenty one patients with six strands graft included prospectively and 35 patients with four strands included retrospectively from previous study. All patients were subjected to the same procedure by the same surgeon. The patients are assessed preoperatively by stability tests and Tegner Lysholm score,then followed up after 6 months and after one year by the same tests and Tegner Lysholm score. Twenty one male patients with six strands graft have age ranging from 20 to 35 years (mean 26.1±3.9). A thirty five patients with four strands were included, their age were (24.6±2) years. In the six strands group (71.6%) were sport men versus (82.8%) in the four strands group. The six strands graft size ranged 8-11 mm with mean (9.9±0.8)mm, while the four strands graft size ranged 7-9.5 mm with mean (8.5mm). After one year the results was instability (9.5%) of the six strands group versus (25.8%) in the four strands group. The mean post- operative Tegner Lysholm score in six strands group was (92.9±6) with excellent in (85%) while it was excellent in (22.8%) of the four strands group, although the mean Lysholm score not mentioned in the previous study. In conclusions, the six strands autologous hamstring graft is an alternative method for ACL reconstruction particularly when the four strands graft cannot provide sufficient size.