Seventy-nine patients undergoing primary ACL reconstruction were randomized to receive either robot-assisted femoral tunnel drilling (n=39) or traditional handheld locator-guided drilling (n=40). The primary outcome was the success rate of femoral tunnel positioning within the ideal anatomical footprint. Secondary outcomes included tibial tunnel position, femoral and tibial tunnel lengths, knee joint stability, surgical time, and adverse events. Outcomes were assessed 1 week postoperatively using 3D CT and clinical knee stability tests. Overall, the results revealed that the robot-assisted group had a significantly higher success rate in femoral tunnel placement, although surgical time was longer. Knee stability outcomes and adverse event rates were comparable between groups. These findings suggest that robot-assisted ACL reconstruction improves femoral tunnel accuracy without compromising safety.