Paediatric ACL injury in a growing knee demands a balance between ligament reconstruction and growth‑plate protection. This video explains why the 12‑week window matters, how physeal‑sparing techniques avoid limb‑length discrepancy, and what to look for beyond the ligament itself. ⏱ Chapters 0:00 Intro 0:28 Two Plates, One Ligament 1:36 Tibial Spine Avulsion On Plain Films… 2:25 Complete Midsubstance ACL Tear With The… 3:13 The Knee-Preservation Problem 3:59 Flipped Medial Meniscal Tear — The Locked… 4:40 The Vascular Paediatric Meniscus… 5:23 Fix Now Or Wait? 7:16 The Physis Decides The Operation 8:24 All-Epiphyseal Reconstruction — Both… 9:13 Meyers–Mckeever Classification… 10:08 Growth, Re-Rupture, And The Other Knee 11:50 Recap & sources The video covers the anatomy of the immature knee, injury patterns including midsubstance tears and tibial spine avulsions, imaging pathways with X‑ray and MRI, the decision‑making framework that weighs instability risk against growth‑plate risk, physeal‑sparing and all‑epiphyseal reconstruction options, rehabilitation principles, and return‑to‑sport criteria. Understanding these elements is essential to preserve the meniscus, prevent growth disturbance, and guide timely, individualized treatment for young patients. 🦴 IN THIS VIDEO YOU'LL LEARN • Identify the key history clues that suggest a paediatric ACL injury • Differentiate tibial spine avulsion from midsubstance ACL tear on X‑ray and MRI • Interpret MRI findings for ligament continuity, meniscal pathology, bone bruising and physeal maturity • Apply the SPINE mnemonic to guide early radiographic evaluation in younger children • Choose an appropriate reconstruction technique based on skeletal maturity using the GROW framework • Recognise the 12‑week threshold after which meniscal injury risk rises significantly • Plan rehabilitation and return‑to‑sport based on functional criteria rather than a fixed timeline • Monitor for growth disturbance post‑reconstruction and understand its true incidence 📌 KEY TAKEAWAYS ✔️ Rapid effusion after a pivot injury is an intra‑articular injury until proven otherwise. ✔️ Tibial spine avulsion is the common ACL‑equivalent injury in skeletally immature children and requires plain X‑ray first. ✔️ Delaying reconstruction beyond ~12 weeks roughly doubles the risk of irreparable meniscal damage. ✔️ Physeal‑sparing techniques keep tunnels within the epiphyses, making clinically significant leg‑length discrepancy rare ( under 2%). ✔️ Return to sport should be guided by motion, strength, neuromuscular control, hop testing and confidence, not by calendar date. ✔️ Always examine the whole knee – meniscus, cartilage, bone bruising and collateral structures – to determine the true urgency. 👩⚕️ WHO THIS IS FOR This video is designed for orthopaedic trainees, medical students, clinicians managing paediatric knee injuries, and interested patients or parents seeking clear, evidence‑based information. 📚 RELATED TOPICS: Tibial spine avulsion fixation · Physeal‑sparing ACL reconstruction techniques · Meniscal repair in the paediatric knee · Return‑to‑sport criteria after ACL reconstruction · Growth plate injury and monitoring · Hybrid ACL reconstruction in adolescents 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #paediatricACL #ACLinjury #growingknee #physessparing #tibialspine #meniscuspreservation #kneeimaging #returntosport #growthplate #orthopaedics #sportsmedicine #pediatrics #ligamentreconstruction #kneepreservation #pediatricortho