PurposeTo gain a deeper understanding of patients’ experiences over 5 years after anterior cruciate ligament (ACL) reconstruction.MethodsSeventeen semi-structured interviews were performed with patients treated with ACL reconstruction at least 5 years earlier without a second knee injury. Interviews were transcribed and analyzed using qualitative content analysis according to methods described by Graneheim and Lundman.ResultsPatients’ long-term experiences after an ACL reconstruction were summarized as: “to cope or not to cope, that is the question”, and five main categories: (1) Adapting life after knee symptom: the past will not come back; (2) An arduous and demanding rehabilitation: sailing against the wind; (3) Accepting what cannot be changed: biting the bullet; (4) Being satisfied with results: end of a chapter; (5) Apprehensively peregrinating on an unknown road.ConclusionsMore than 5 years after ACL reconstruction, patients can experience full symptom resolution and the ACL injury process as positive, or experience persistent symptoms and are forced to accept negative life-changing choices due to the injury.Level of evidenceIV.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00167-022-07271-1.