This video demonstrates a successful surgical technique for anterior cruciate ligament (ACL) repair in an adult with a tibial spine avulsion fracture via suture fixation. The case presentation of a healthy 27-year-old man who sustained a tibial spine avulsion fracture after a hyperextension injury to the right knee is discussed. Imaging studies demonstrated complete avulsion of the ACL off the tibial footprint with a small piece of bone, which was confirmed during knee arthroscopy. Arthroscopic suture repair of the ACL and the bone fragment was performed in six main steps. First, a traction stitch was placed in the anterolateral ACL for manipulation. Second, two anchoring sutures were placed around the posterior aspect of the ACL bone interface. Third, sutures with a closed loop on one end were placed in the anterolateral and anteromedial portions of the ACL bone fragment. This allowed the ACL lasso sutures to be drawn through the bone fragments. Fourth, two parallel bone tunnels were drilled through the tibia, and the ACL lasso sutures were pulled through. Fifth, the fragment was reduced, and the sutures were tied to each other over a 1.5-cm bone bridge with the knee in 30° of flexion. Lastly, suture fixation was secured with the use of a knotless suture anchor distal to the tibial bone tunnels. Postoperatively, the patient's leg was placed in a hinged knee brace, and partial-weight bearing was permitted. The patient resumed running approximately 3 months postoperatively.