Abstract Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone‐tendon‐bone (C‐BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return‐to‐sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C‐BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I‐BTB) ACL reconstruction. The clinical outcomes of the time of return‐to‐sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C‐BTB group and 8.0 months in the I‐BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL‐reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C‐BTB group and 70.0% in the I‐BTB group (p
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