ligament it is preferred to use number 5 nonabsorbable suture in the extra articular procedure to create a double layer of 34 synthetic 34 extra articular ligament the position of the extra articular procedure is optimized by putting the screw directly at krackow 39 s point with a cancellous screw and toothed washer the isometricity of both the intra articular repair and the extra articular augumentation are checked on the operating table by taking the knee through a full range of motion the screw fixation also allows immediate motion in a cpm machine and subsequent passive extension during the first week of postoperative treatment in the case of mid substance acl tears especially in young athletic individuals a patella tendon intra articular augmentation may be utilized preferrably repairing the anterior cruciate stump around the patella tendon graft is accomplished with a double needle multiple loop technique this enhances blood supply from the ligament stump on the tibial end in a situation where there is a young athletic individual with associated pathology such as meniscus tears the use of the patella tendon augmentaation is more aggressively applied from a review of such patients the 34 isolated 34 anterior cruciate tears do quite well with an intra articular double needle multiple loop repair technique patients that require patella tendon augmentation tend to have more associated pathology and also are more competitive individuals in summary the double needle multiple loop anterior cruciate ligament repair technique with extra articular augmentation appears to be a viable alternative in the slightly older individuals and those that are recreational athletes in a test of this technique.