Nogaro MC, et al. - Researchers applied a national database to look at trends in an anterior cruciate ligament (ACL) reconstruction and rates of serious complications, growth disturbance, and revision surgery, over 20 years. Between 1 April 1997 and 31 March 2017, all hospital episodes for individuals undergoing ACL reconstruction, under the age of 20 years, were extracted by procedure code from the national Hospital Episode Statistics. A total of 16,125 ACL reconstructions were included over the 20 year period (the mean age of patients was 16.9 years [SD 2.0; 27.1% female, n = 4,374/16,125]). Over the last 20 years, rates of pediatric and adolescent ACL reconstruction have risen 29-fold. The risk of serious complications, including further surgery for growth disturbance, is very low, notwithstanding the growing rate in the younger population. In the pediatric and adolescent population, this study gives a point of reference for shared decision making in the management of ACL injury.