Value in anterior cruciate reconstruction can be improved by focusing on outcomes relative to cost at each stage of care. Timely diagnosis and prehabilitation reduce rates of meniscal injury and return-to-sport time. Outpatient surgery centers, cost-conscious graft selection, and avoidance of low-value practices such as routine bracing, continuous passive motion, and unnecessary imaging further enhance value. Functional testing before return to sport decreases reinjury and costly revision surgery. Shared decision-making with families—particularly around timing of return to high-risk sports—remains central to achieving the best balance of outcomes and cost in pediatric and adolescent patients.