Highlight
– Transphyseal ACL reconstruction performed within two years of skeletal maturity largely preserves coronal and sagittal plane alignment in the majority of patients.
– A meaningful subset (16%-28%) experience clinically significant changes, primarily valgus deformity and decreased posterior tibial slope.
– Routine preoperative and postoperative radiographic assessment is critical to detect and manage growth-related alignment disturbances early.
– There is a need to establish intervention thresholds for guided growth in patients predisposed to progressive deformities.
