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Medial collateral ligament injuries are common in pediatric and adolescent patients, yet are frequently overlooked. Published literature has reported on the unique anatomic, biomechanical, and non-surgical and surgical management strategies specific to this age group. A multidisciplinary committee of pediatric orthopaedic sports medicine surgeons and physical therapists from the Pediatric Research in Sports Medicine (PRISM) Knee Ligament Research Interest Group (RIG) produced this current concepts review through critical appraisal of recently published literature on the topic of pediatric knee Medial Collateral Ligament (MCL) injuries. MCL injuries in young athletes have been shown to constitute a high percentage of all sports related injuries with MCL injuries. Injury assessment in this age group must include a comprehensive knee exam evaluating for associated injuries unique to developing patients. Imaging should include a 4 view knee series, stress radiographs, and alignment films to guide and follow treatment. To optimize patient outcomes, a detailed understanding of patient specific factors related to knee anatomy and biomechanics during development are essential, along with appropriate characterization and classification of injury severity. While the majority of MCL injuries in this age group can be managed non-surgically with a thoughtful approach to rehabilitation, some injuries based on clinical and radiographic assessment may benefit from surgical intervention. MCL injuries can present decision making challenges related to primary repair versus reconstruction all while restoring normal anatomy and mechanics to the knee without compromising patient growth and development. Special considerations also apply to the rehabilitation process for both non-operatively and operatively managed MCL injuries in this age group. This current concepts review was assembled by a multidisciplinary committee of pediatric sports medicine specialists to better define anatomic, clinical, and treatment applications unique to the pediatric and adolescent patient with a knee MCL injury. MCL injuries in pediatric and adolescent patients can be managed safely and effectively, but a nuanced approach is required to optimize outcomes in this unique patient population.