Anterior cruciate ligament (ACL) tears in children and adolescents are becoming more common. While early literature supported a delay of treatment until skeletal maturity, recent studies have supported early ACL reconstruction to prevent additional meniscal or cartilaginous injury. Several different treatment options are available for the skeletally immature patient. Surgical options include transphyseal ACL reconstruction similar to that performed in adults, hybrid techniques, and all-epiphyseal techniques. This review describes the natural history, diagnosis, imaging, and treatment options available for ACL tears in young patients with emphasis on articles published within the past 12 mo.