Chouhan DK, et al. – This systematic review intends to define the outcomes after open reduction and internal fixation of late presenting anterior cruciate ligament (ACL) avulsion fractures, and to review the literature for similar cases, in an attempt to evaluate the ideal surgical management in this unique scenario. For late presenting ACL avulsion fractures, mini–open fixation allows accurate, anatomic reduction and stable fixation with screws, and should be the preferred method of fixation. Embedding the fragment deep into the crater or size reduction is key to preventing extension deficits.