Anterior cruciate ligament (ACL) avulsion fractures are commonly seen in the pediatric population and occur when a bone fragment is displaced from the tibial plateau. This type of fracture is typically caused due to a strain exerted by the ACL on the tibial insertion site. Although the injury mechanism is similar to that of an ACL tear, the biomechanical force involved leads to the avulsion of the insertion site, resulting in anteroposterior joint laxity. Treatment decisions are primarily guided by the McKeever classification, which considers both the size and, more importantly, the degree of displacement of the avulsed fragment. Nondisplaced avulsion fractures can generally be managed nonsurgically, while displaced fractures typically require surgical fixation. Various arthroscopic repair techniques may be used based on the size of the bony fragment.