Outcomes of All-Epiphyseal Anterior Cruciate Ligament (ACL) Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-Analysis.

All-epiphyseal reconstruction of the anterior cruciate ligament (ACL) has gained traction as a way to stabilise the knees of children and adolescents, without violating their open physes. Nevertheless, evidence is still mixed regarding its clinical benefits and complication profile. This systematic review and meta-analysis, therefore, set out to determine the procedure's effectiveness and safety in paediatric patients with open growth plates. PubMed, Scopus, Web of Science, and Google Scholar were systematically searched up to July 2025 for studies reporting outcomes of all-epiphyseal ACL reconstruction in skeletally immature patients. Eligible studies reported at least one clinical or radiological outcome. Meta-analyses were performed using standardised mean differences (SMDs) and odds ratios (ORs). Six studies (n = 150 patients) were included. Meta-analysis showed a significant improvement in Lysholm knee function scores after all-epiphyseal ACL reconstruction (SMD = -2.54; 95% CI: -2.90 to -2.17; p < 0.00001), and a marked reduction in the odds of a positive Lachman test indicating instability (OR = 1026.65; 95% CI: 142.49 to 7397.31; p < 0.00001). Most patients (up to 96%) returned to sport within 8-14 months. The risk of clinically significant growth disturbance was low (<2%), and graft failure rates ranged from 4% to 17%. Mild limb overgrowth was reported, but it is rarely clinically relevant. All-epiphyseal ACL reconstruction provides excellent knee function and stability, with a low risk of growth disturbance in skeletally immature patients. Careful technique and long-term follow-up are recommended to minimise complications.