The article describes a simple technique for anatomic anterior cruciate ligament (ACL) tibial graft fixation at the level of the intercondylar floor within a standard endoscopic tibial tunnel. Fixation is achieved with a retrograde positioned cannulated bio-interference screw delivered over a No. 5 permanent suture from a standard anteromedial portal. The screw is inserted into the tibial tunnel in an inside-out position, so that the head of the screw is flush with the intra-articular orifice of the tibial tunnel. Recent experimental, animal, and clinical studies have reported that the advantages of this type of anatomic graft fixation over nonanatomic tibial graft fixation include increased fixation strength, a more stable reconstruction through full knee range of motion, absence of postoperative tunnel expansion, and final biologic graft incorporation at or near the native ACL tibial insertion.