The utilization of cost-effectiveness analysis is of great significance within the field of orthopaedic surgery, as it enables informed decision-making by evaluating the relationship between treatment costs and patient outcomes. The selection of a graft for anterior cruciate ligament reconstruction (ACLR) is a pivotal factor in determining the efficacy of the surgical procedure and the subsequent results experienced by the patient. The choice of graft material, whether it is autograft or allograft, has a substantial impact on the results of surgical procedures. The selection process necessitates meticulous evaluation of various aspects, including the age of the patient, their level of physical activity, the availability of suitable grafts, and the expertise of the surgeon. The present article aims to critically review the economical clinical studies conducted for cost-effectiveness comparison between graft choice in ACLR. However, the selection of grafts in ACLR is an ongoing area of study, as there is currently no universally recommended graft that consistently produces optimal patient outcomes and satisfaction.