CASE: A 13-year-old adolescent boy presented with chronic anterior cruciate ligament (ACL) insufficiency and prior medial meniscectomy. Radiographic evaluation revealed a posterior tibial slope (PTS) of 20°, putting him at high risk of reinjury following ACL reconstruction (ACLR). Guided growth using anteriorly placed eight plates was used for 9 months, which reduced his PTS to 6°. Two months following plate removal, the patient underwent ACLR with lateral extra-articular tenodesis. CONCLUSION: This previously proposed but never reported approach suggests that guided growth is a viable option to correct excessive PTS before ACLR in skeletally immature patients.