Arthroscopic surgeries, which are widely used for anterior cruciate ligament (ACL) reconstruction, not only require advanced hand–eye coordination but also involve complicated surgical procedure, necessitating simulation-based training for surgeons. This paper describes a surgical procedure simulation system for the training of arthroscopic ACL reconstruction. Different from existing simulation-based training systems for basic surgical skills, this system provides a complete simulation for the entire procedure of arthroscopic ACL reconstruction, involving operations such as puncturing, probing, incision, and drilling. In this system, we employ a linear elastic finite element method and position-based dynamics for deformable modeling. Simplified vertex duplicating method and an implementation of real-time Boolean operations are proposed for the topological change of tissue models involved in the incision simulation and tunnel construction. Two specially designed force feedback models are introduced for the haptic rendering of probing and drilling operations. By using these fast and stable simulation methods, this system is able to provide real-time realistic graphical and haptic feedback to the user, making it efficient and practical for training purpose. Feedback from the surgeon trainees shows that this system is very effective in training not only for basic surgical skills but also for the complex surgical procedure. Copyright © 2012 John Wiley & Sons, Ltd.