Patel NM, et al. - In this retrospective study, researchers compared clinical outcomes and complications between all-epiphyseal and pediatric transphyseal anterior cruciate ligament reconstruction (ACLR). Between 2000 and 2015, 1,056 pediatric patients undergoing primary ACLR were reviewed. One hundred sixty-two patients underwent all-epiphyseal reconstruction (mean age, 12.1 ± 1.8 years) and 843 underwent transphyseal ACLR (mean age, 15.8 ± 1.9 years) during the study period. There was no distinction in these postoperative complications (including graft rupture, contralateral anterior cruciate ligament [ACL] tear, and meniscus injuries) between all-epiphyseal and transphyseal ACLR after controlling for confounders in a multivariate model. Compared with older children undergoing transphyseal reconstruction, skeletally immature patients undergoing all-epiphyseal ACLR had less irreparable meniscus tears. There was no distinction in postoperative ROM or strength after adjusting for age and other confounders, nor an increased risk of graft rupture, contralateral ACL injury, or new meniscus tear in these young patients vs older adolescents undergoing transphyseal ACLR.