CASE: Fourteen-year-old boy, history of autism presented with bilateral knee instability. Imaging revealed bilateral anterior cruciate ligament (ACL) insufficiency, 20° of posterior tibial slope (PTS) on the right and 18° on the left. A guided growth technique using anterior placed tension band plates was used to correct the PTS. At 22 months, the PTS corrected to 5.5° on the right and 6° on the left. The patient's knee stability improved, and he resumed activities at 30 months. CONCLUSION: Pediatric ACL insufficiency in the setting of elevated PTS can be successfully corrected with a guided growth technique.