In this article, Dr. Marx provides an overview and comparison of the various graft types to aid in the graft choice decision making process for paediatric ACL reconstruction (ACLR). The paediatric population is at particularly high risk for anterior cruciate ligament (ACL) injuries due to high rates of sports participation. Other risk factors for ACL injuries in children include but are not limited to being female, generalised ligamentous laxity, a high body mass index (BMI), and poor neuromuscular control. Special consideration must be taken in ACLR in the skeletally immature patient due to the risk of growth-related complications, such as limb deformity or growth arrest, that can arise from drilling across or disrupting the physis. Graft choices for paediatric ACLR include iliotibial band (ITB) over the top and over the front, hamstring autograft, bone patellar tendon bone (BTB) autograft, quadriceps tendon autograft, and allograft. Each graft has its benefits and disadvantages for the individual patient, depending on age, skeletal maturity, and goals for recovery. After surgery, patient follow-up until at least the growth plates are closed is important.