Growth Disturbance in Physeal Sparing ACL Reconstruction: A Comparison of 3 ACLR Techniques in Skeletally Immature Patients

Background: In pediatric anterior cruciate ligament reconstruction (ACLR), there exists a potential to injure the open physis in skeletally immature patients and cause growth disturbance. Thus, there is a need to determine the optimal ACLR technique for this population. Purpose: To evaluate the functional outcomes and rates of physeal disturbance, graft failure, and reoperation after transphyseal and physeal-protecting techniques—including extraphyseal intra-articular and partial epiphyseal ACLR—within the skeletally immature population. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary ACLR from June 2018 to April 2023 at a tertiary pediatric hospital were identified. The exclusion criteria included skeletal maturity based on preoperative magnetic resonance imaging, concomitant multi-ligamentous injury, excluding medial collateral ligament sprain that did not require surgical intervention, and