Knee conditions
Pediatric ACL Reconstruction
ACL tears in children and teenagers, reconstructed with techniques chosen around the growing knee.
The anterior cruciate ligament (ACL) is one of the two ligaments that cross inside the knee and keep it stable. In children and adolescents it is usually torn in sport — a twisting movement, a landing, or a direct blow. Dr. Green’s practice is almost exclusively knee surgery in children, teenagers and young adults, and the ACL is the single condition he has published on most.
Why the growing knee changes the operation
A child who is still growing has open growth plates at the lower end of the thigh bone and the upper end of the shin bone. A standard adult ACL reconstruction drills tunnels straight across those plates. In a child with significant growth remaining, that is the thing the operation has to be designed around.
This is why the same injury is not the same operation at 9, at 14 and at 18 — and why skeletal maturity, not age alone, drives the plan.
How Dr. Green decides between surgery and non-surgical treatmentThe three reconstruction techniques Dr. Green uses in a growing knee
- Physeal-sparing and all-epiphyseal reconstruction Techniques that route the new ligament around or entirely below the growth plate, for children who still have significant growing to do.
- Quadriceps tendon graft A graft taken from the quadriceps tendon, used in adolescent reconstruction.
- Lateral extra-articular tenodesis (LET) An additional procedure on the outer side of the knee, performed alongside the ACL reconstruction in selected patients.
Dr. Green's published research on the pediatric ACL
Of the papers indexed on PubMed under Dr. Green’s Hospital for Special Surgery affiliation, 49 are on the anterior cruciate ligament — the largest single subject in his bibliography. He is an active member of the multicenter pediatric knee study groups, including the PLUTO ACL study.
See the full publication recordDr. Green co-authored HSS’s clinical articles on the ACL
ACL Tear (Torn ACL) and ACL Surgery appear in the HSS health library with Shevaun Mackie Doyle, MD and Peter D. Fabricant, MD, MPH. He is author 3 on the first and author 4 on the second. Both are HSS’s, and they are published there rather than reproduced here.
Read them on hss.eduDr. Green’s published research on the pediatric ACL
The 8 most recent of his 49 papers on the anterior cruciate ligament — the largest single subject in his bibliography — indexed on PubMed under his Hospital for Special Surgery affiliation. Each opens on PubMed.
- Differential Arterial Supply of the ACL and PCL Revealed by 7T-qMRI, Histology, and Micro-CT Orthopaedic journal of sports medicine · 2026 Aug · Dr. Green is author 11 of 11
- Internal versus external femorotibial rotation an anterior cruciate ligament rupture and patellofemoral instability on preoperative standing radiographs The Knee · 2026 Aug 27 · Dr. Green is author 14 of 14
- Is the Greulich and Pyle Bone Atlas Suitable When Measuring Bone Age for Pediatric ACL Reconstruction in the Modern US Population? Analysis Within the PLUTO Prospective Multicenter Cohort Study Journal of pediatric orthopedics · 2026 Aug 1 · Dr. Green is author 12 of 26
- Greater Valgus Alignment in Pediatric and Adolescent Patients with a Primary ACL Tear Compared with Healthy Controls The Journal of bone and joint surgery. American volume · 2026 Jun 3 · Dr. Green is author 6 of 7
- Increased operative time is an independent risk factor for surgical complications following isolated anterior cruciate ligament reconstruction in skeletally immature patients Journal of experimental orthopaedics · 2026 Apr · Dr. Green is author 3 of 11
- Validation of the ACL Return to Sport after Injury (ACL-RSI) Scale in Pediatric and Adolescent Patients After Medial Patellofemoral Ligament Reconstruction Orthopaedic journal of sports medicine · 2026 May · Dr. Green is author 10 of 11
- Comparison of preoperative mechanical axis alignment in pediatric and adolescent patients with anterior cruciate ligament rupture and patellofemoral instability The Knee · 2025 Dec · Dr. Green is author 9 of 9
- Age and Sex-based Frequency of Graft and Technique Used in Pediatric Anterior Cruciate Ligament Reconstruction: A Multicenter Study Journal of pediatric orthopedics · 2025 Sep 1 · Dr. Green is author 6 of 13
Patients Dr. Green has treated for an ACL tear
ACL Tear (Torn ACL) Elizabeth Goldstein Forest Hills, NY Read Elizabeth’s story 
ACL Tear (Torn ACL) Michael Siroty Westfield, NJ Read Michael’s story 
ACL Tear (Torn ACL) Luke Bower Raleigh, NC Read Luke’s story 
ACL Tear (Torn ACL) Serverino Roderick Bohemia, NY Read Serverino’s story 
ACL Tear (Torn ACL) Aleena Abrahamsen Freehold, NJ Read Aleena’s story 
ACL Tear (Torn ACL) Elle Manley Belle Harbor, NY Read Elle’s story Questions parents ask
Why is an ACL tear treated differently in a child?
Because a growing child still has open growth plates at the lower end of the thigh bone and the upper end of the shin. A standard adult reconstruction drills across those plates. In a child with significant growth remaining, Dr. Green uses physeal-sparing and all-epiphyseal techniques that work around them.
What is lateral extra-articular tenodesis?
LET is a procedure on the outer side of the knee performed in addition to the ACL reconstruction itself. Dr. Green lists it among the techniques he uses; whether it is appropriate is decided case by case.