Purpose: Meniscal injuries are increasingly common in older age groups. Age is often cited as a contraindication to undergoing meniscal repair due to concerns regarding failure rates. There has recently, however, been an increasing shift towards repair in older populations. The purpose of this study was to review outcomes of meniscal repair in patients over the age of 40. Methods: A systematic search of the following databases was conducted of PubMed, SCOPUS, Web of Science, and Cochrane Library to identify studies reporting failure rates of patients over 40 with meniscal injuries undergoing repair. The definition of meniscus failure was noted for each study evaluated in this systematic review. Further data surrounding clinical and radiological outcomes were recorded and evaluated, when available. Results: Thirteen studies were included in this review, encompassing a total of 316 meniscal repairs in patients over the age of 40 years. The overall failure rate was found to be 15.5% (49/316) (range 0–33.3%). There was no difference in the failure rate in those over 40 vs. under 40, and the two groups had equivalent functional outcomes. Conclusions: Age should not be considered a contra-indication for meniscal repair. Appropriately selected older patients can have acceptably low failure rates with meniscal repair and similar functional outcomes to those under the age of forty. Meniscal repairs in those over 40 achieved better functional outcomes than patients of the same age group who underwent meniscectomy.

Background: Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs. Methods: A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included. Results: Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF (p = 0.45) and screws (p = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability (p < 0.0001), reoperation (p = 0.01), and post-operative pain (p = 0.007) with screw fixation compared to sutures. Conclusions: While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques.

Background/objectives: Multi-ligament knee injuries (MLKIs) present complex surgical challenges, and there remains no consensus on whether single-stage or staged reconstruction yields superior outcomes. This study aimed to assess differences in complications, functional outcomes, and return-to-sport rates between single-stage and staged surgical approaches. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. Four databases (PubMed, Scopus, Embase, and the Cochrane Library) were searched for studies published between 2000 and 2025. Eligible studies reported surgical management of MLKIs and specified either single-stage or multi-stage reconstruction. Data on complications, functional scores (Lysholm), return to sport, rehabilitation protocols, and graft type were extracted and analyzed using descriptive statistics and study-level regression models. Results: A total of 43 studies encompassing 2086 patients were included (1900 single-stage; 186 multi-stage). Staged reconstruction was associated with a significantly lower rate of arthrofibrosis (1.95% vs. 7.29%; OR 3.96, p = 0.007), higher Lysholm scores (+4.7 points, p < 0.001), and higher return-to-sport rates (48% vs. 65%, p = 0.001) compared to single-stage. Use of synthetic grafts increased the risk of arthrofibrosis (OR 4.09, p = 0.031). Early mobilization and weightbearing were not associated with increased arthrofibrosis risk. Conclusions: Staged reconstruction may yield better functional outcomes and lower complication rates—particularly arthrofibrosis, compared to single-stage approaches. These findings support an individualized surgical strategy, guided by injury complexity, graft selection, rehabilitation goals, and patient-specific functional demands.