In Marshall's multiple suture technique for ACL tear suture of only tibial end may be enough or even better than suture of both ends. To clarify this point the results of sutures of both tibial and femoral ends (open technique) in 50 patients (group 1) were compared with the results of sutures of only tibial ends (arthroscopic technique using Caspari suture punch) in 20 patients (group 2). Anterior displacement of the tibial condyle in Lachman test with knee laxity tester (stryker) was recorded. Grade 0 was defined as 0-1 mm of anterior translation of the tibial condyle. Grade I was divided into 2 subgrades. Grade I a was a laxity of 2-3 mm, in which no pivot shift phenomenon was detected. Grade I b was a laxity of 4-5 mm with positive pivot shift test. Grade II was a laxity of 6-10 mm, and grade III was a laxity of 11 mm or more. In case of associated MCL or LCL tear the valgus and varus laxity were also recorded. The average follow-up period was 41.3 months (18-74 months) in group 1 and 15.3 months (12-23 months) in group 2. Results: There was no case of grade II or III at final follow-up. In group 1 44 out of 50 knees (88.0%) showed grade I a and the rest of 6 knees(12.0%) showed grade I b. In group 2 all knees (100%) showed grade I a. There was one case of infection in group 1, which was eventually controlled. The range of motion was regained in all cases at final follow-up. Thus, these results suggested that 1) arthroscopic technique was at least comparable to open technique, and 2) suture of only tibial end is enough or even better than the suture of both tibial and femoral ends.