Representation of different pediatric ACL reconstruction techniques in lateral knee views. Surgeons differentiate between transphyseal and physeal sparing techniques. The former implicate drilling of a bone tunnel through the femoral and tibial growth plate whereas the latter do not cause any direct iatrogenic physeal injuries, but bear the risk of indirect damage to the growth plate. The ACL grafts are placed either within the epiphysis or turn around the physis. Many surgeons use different techniques on the femoral and the tibial side.