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Anterior cruciate ligament (ACL) tears account for a significant and increaseing number of sports related injuries in young athletes. There are several described techniques for "physeal respecting" ACL reconstruction. Each described technique distinguishes itself in a variety of ways. The goal of this invited perspectives article is to dicuss pediatric sports medicine experts' approach, preferred ACL reconstruction techniques, and rationale when evaluating a skeletally immature patient with an ACL tear.