Early reconstruction after anterior cruciate ligament (ACL) rupture in children with open physis was found to be a better strategy compared with delayed ACL reconstruction at skeletal maturity. This article focuses on an original technique for ACL reconstruction in children and adolescents. The rationale of the procedure is based on avoiding the danger of a femoral tunnel and fixation systems that may lead to growth arrest. Part of the quadriceps tendon with a trapezoidal patella bone block was harvested after arthroscopic exploration and addressing other intra-articular injuries like meniscal tears. The bone-tendon graft was inserted through a combined intraepiphyseal femoral tunnel drilled from outside-in under fluoroscopic imaging and a long vertical arthroscopically drilled transphyseal tibial tunnel. The bone block was impacted in the femoral tunnel, allowing primary fixation without any associated material. The tibial fixation is obtained with a strictly metaphyseal screw and postfixation with a staple. The advantages of the technique are multiple: anatomic and isometric reconstruction, arthroscopically surgery, strong adaptable long graft with excellent bone to bone press-fit fixation on the femur, and preservation of the femoral physis. Indications, the step-by-step procedure, postoperative care, complications, and results are reported in this paper.