Introduction: Looking at the controversial discussion about indication, transplant choice and fixation techniques in active ACL-injured patients with open physes we recommend even in childhood an ACL reconstruction using a quadruple hamstring graft.

Material and Methods: ACL-replacement was performed with a four strand hamstring graft using an Endobutton and a suture washer or staple for extracortical fixation. The drilled tunnels were positioned transepiphyseal in the anatomic position. A standardized examination was performed. IKDC, Tegner, Lysholm and Cincinatti Knee Score were raised. With the KT-1000 the functional stability was tested. Variation in leg length and leg deformity were analyzed.

Results: 54 patients (22 female/32 male) operated at an age between 8 to 16 years (mean 13.3) were examined at mean f/u of 32 months (range 12–90) postoperatively. Measured with the Cincinatti and Lysholm Score 94% were classified as normal or nearly normal. Mean Tegner Score difference before trauma and postoperatively was 0.29 (range 0–3). Four patients developed instability due to an adequate trauma. Clinical and radiological examinations did not show growth disturbances in any patient. The results did not correlate to gender.

Conclusion: Presuming a bad progression in conservatively treated ACL-injured young patients and performing a careful operative treatment (small tunnel diameters, ligamentous graft, extracortical fixation, etc.) the above mentioned technique shows satisfying results and should be considered as a standard treatment in this special group.