• Filippo Migliorini, Federico Cocconi, Luise Schäfer, Raju Vaishya, Daniel Kämmer, and Nicola Maffulli.
• Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Via Lorenz Böhler 5, 39100, Bolzano, Italy.
• Br. Med. Bull. 2024 Sep 27.

IntroductionHistorically, anterior cruciate ligament (ACL) ruptures in the paediatric age group were managed conservatively with bracing, casting, activity modification, and physical therapy. However, most of these patients had to reduce their sports activities, and secondary damages to the affected knee were prevalent.Source Of DataPublished scientific literature in Embase, Web of Science, PubMed, and Google Scholar databases.Areas Of AgreementACL reconstruction in children with open physes patients is debated. Any damage to the physes around the knee could lead to growth abnormalities and axial deviation of the knee.Areas Of ControversyDifferent grafts are available and suitable for ACL reconstruction in skeletally immature patients; however, which graft performs better remains unclear.Growing PointsThis systematic review compared bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts for ACL reconstruction in skeletally immature patients. The joint laxity, Patient-reported outcome measures (PROMs), return to sport, and complications were compared.Areas Timely For Developing ResearchIn skeletally immature patients, HT, BPTB, and QT autografts for ACL reconstruction yielded good outcomes. Comparative studies are strongly required to establish the most suitable autograft.© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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