INTRODUCTION: Anterior cruciate ligament (ACL) injuries in children and adolescents with open physes are common. AREAS OF AGREEMENT: Evidence of ACL reconstruction using allografts in children with open physes is limited. AREAS OF CONTROVERSY: Whether the outcomes of ACL allograft reconstruction in children and adolescents with open physes are superior to autograft ACL reconstruction is unclear, with contrasting evidence. SOURCE OF DATA: In October 2024, the Web of Science, PubMed, and Embase were accessed with no additional filters. Only clinical investigations evaluating ACL reconstruction in children or adolescents with open physes were eligible. Only studies reporting a minimum length of 24 months of follow-up were included. AREAS TIMELY FOR DEVELOPING RESEARCH: Children who undergo allograft ACL reconstruction demonstrate similar functional outcomes to those who undergo autograft ACL reconstruction. Although allografts allow a faster return to sport, the greater laxity, the reduced activity level, and the higher failure and reoperation rates make their use dubious as a first-choice option for ACL reconstruction in skeletally immature patients.