Anterior cruciate ligament (ACL) injuries in children and adolescents require specific management, which differs from management of adults. In children and adolescents, there are additional challenges and concerns regarding ACL reconstruction. The reason for this is largely due to the open growth plates and remaining growth potential. The chapter provides an overview of pediatric ACL injury diagnosis, management, and prognosis. The main focus is on ACL reconstruction, including a review of surgical techniques and relevant additional procedures such as meniscal surgery and lateral extra-articular tenodesis (LET). The chapter also addresses strategies on how to protect and minimize the involvement of the growth plates during ACL reconstruction. Finally, the chapter outlines clinical outcomes and prognosis following pediatric ACL reconstruction, including patient-reported outcome measures (PROMs), risk of re-injury, growth disturbances, rate of return to sports, and potential development of secondary osteoarthritis.