This chapter highlights the increasing incidence of anterior cruciate ligament (ACL) injuries in the pediatric and adolescent population over the past several decades and the natural history of these injuries when treated nonoperatively. As these ACL injuries are often associated with meniscal and chondral injuries, they can have consequential impact on the status of the patient’s knee joint both acutely and throughout life. However, there is significant literature that many pediatric patients can return to sport with nonoperative treatment of ACL injuries. Given the increasing prevalence of these injuries in the pediatric population, many injury prevention programs have been developed. ACL risk factors in the pediatric population particularly in female athletes and the success of these ACL prevention programs are highlighted in this chapter.