BACKGROUND: Pretibial lacerations are a common and costly injury in elderly patients. At present, no standardised evidence-based guidelines exist to aid in their management. This systematic review aims to collate and evaluate all available evidence on the assessment and management of pretibial lacerations, including outcomes such as wound healing time, complications and mortality. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL, and clinicaltrials.gov was conducted from inception to November 2024. Studies were eligible if they investigated patients with pretibial lacerations and reported at least one clinical outcome. RESULTS: Twenty-nine studies published between 1973 and 2023 were included. This included 11 case series, 12 cohort studies and six randomised controlled trials, with a total of 2893 patients. The weighted mean age for patients was 75.4 years. For studies that reported gender data, 85.1% were female. Management strategies varied widely, with 12 studies reporting operative management, four reporting non-operative management and 13 reporting both. Operative management was associated with shorter healing times compared to non-operative management. Infection was the most common complication across both groups (0% to 63%). One month mortality rates were as high as 15%. Risk of bias was high in the majority (55%) of studies. CONCLUSION: Considerable variability exists in the assessment and management of pretibial lacerations, with a lack of high-quality evidence to inform clinical practice. Further research is required to establish best practice for this common injury within our ageing population.