Knee injuries in the skeletally immature patient is a common presentation.  Surgery may be required when non-surgical measures have been exhausted without alleviation of symptoms.  Open growth plates present a surgical challenge and must be respected alongside considerations of bone age, mechanical alignment, and access to specialist rehabilitation.  This talk will focus on the surgical indications and management of anterior cruciate ligament (ACL) injuries, traumatic and atraumatic osteochondral lesions, meniscal tears including discoid menisci, and traction apophysitis.