Anterior cruciate ligament injuries in the pediatric population have been increasing in recent years. While reconstruction can often provide the best chance of restoring stability and preventing degenerative joint disease, the skeletally immature patient with open physes can represent a treatment challenge to the orthopaedic surgeon. Here, we present a technique developed by the senior author that uses two-dimensional fluoroscopy, obviating the need for computed tomography imaging. Intraoperative technical details of this procedure are highlighted. This technique allows the orthopaedic surgeon to reconstruct the ligament in a physeal-sparing manner without the need for intraoperative computed tomography scanning, and with less risk of radiation exposure.