The anterior cruciate ligament injury in patients with immature skeleton seems to have an increasing incidence. The conservative treatment has poor results; the young patients have high physical activity with difficulty to decrease their activity level, and recidivate knee twist may occur. Because of this complicated situation, the surgical treatment in these patients has been advocated. However, the type of surgery that should be performed is not yet well defined. The risk of growth abnormalities (length discrepancies or angular deviation) worries surgeons and patients, and different techniques are described; some are totally physeal sparing, partially physeal sparing, or even transphyseal. Based on clinical and basic science studies, we perform a transphyseal anterior cruciate ligament reconstruction in patients with open physis, drilling through the tibial and femoral physis, using the hamstring tendons (semitendinosus and gracilis) as a graft. In our experience, the results are encouraging, and no clinical growth abnormality has been observed. It is important to mention that our experience has a small number of patients, and a larger comparative study with long-term follow-up is needed to confirm this technique as first choice for patients with open physis.