Background <p>The purpose of this systematic review was to analyze the existing literature on pediatric knee avulsion fractures regarding injury patterns, treatment strategies, and clinical outcomes. We aimed to identify evidence gaps and highlight the need for standardized diagnostic and therapeutic approaches for these clinically relevant injuries.</p> Methods <p>The systematic review was registered on PROSPERO and conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed and Cochrane databases was performed to identify peer-reviewed studies focusing exclusively on pediatric patients with avulsion fractures of the knee. Data on patient characteristics, treatment strategies, and clinical outcomes were extracted for qualitative analysis.</p> Results <p>Eighty-three studies, comprising 1,676 patients (mean age 13.1 years), were included. The majority were case reports or case series, with an overall low level of evidence. Heterogeneity in treatment approaches, follow-up, and outcome measures limited comparability and precluded meta-analysis. Tibial eminence fractures (32.5%) and tibial tubercle fractures (18.1%) were most described, followed by rare injuries such as patellar avulsions, PCL and ACL avulsions. Surgical treatment is predominated, typically involving screw or suture fixation. Notably, tibial eminence fractures frequently presented with concomitant meniscal or chondral injuries (up to 40%), prompting recommendations for routine MRI diagnostics. Postoperative outcomes were generally favorable, with high rates of full range of motion and return to sport.</p> Conclusion <p>Pediatric knee avulsion fractures show diverse injury patterns with limited evidence on optimal management. Despite generally favorable outcomes, data heterogeneity and the lack of standardized treatment underscore the need for multicenter prospective studies. Future research should aim to establish evidence-based diagnostic and therapeutic protocols.</p>