Anterior cruciate ligament (ACL) injuries in pediatric patients present unique challenges due to the anatomical and physiological differences compared to adults. Conservative or surgical treatment can be used to treat pediatric ACL injuries. Both treatments have their own advantages and disadvantages. The most important disadvantage of conservative treatment is the increased risk of associated injuries. There are primary repair and reconstruction options in surgical treatment. It is often necessary to perform non-ideal reconstruction due to open physes. Therefore, the reconstruction technique should be decided according to the age of the patient. In this chapter, all aspects of the management of pediatric ACL injuries will be discussed.