Background <p>Studies comparing arthroscopic surgery with open reduction internal fixation (ORIF) for posterior cruciate ligament (PCL) tibial avulsion fracture have exploded in recent years; however, the results are not consistent. This meta-analysis aimed to summarize the efficacy and safety profile of arthroscopic surgery and ORIF in patients with PCL tibial avulsion fracture.</p> Methods <p>Relevant studies were searched across the Web of Science, PubMed, EMBASE, Wan Fang, CNKI, and VIP databases. The standardized mean difference (SMD) or odds ratio (OR) with 95% confidence interval (CI) was pooled for analyses.</p> Results <p>Twenty-seven studies were included in this meta-analysis. Compared with those in the ORIF group, the incision length (SMD: -4.701, 95%CI: -5.717~-3.686), perioperative bleeding (SMD: -3.304, 95%CI: -3.834~-2.774), postoperative drainage volume (SMD: -1.071, 95%CI: -1.870~-0.273), time to first ambulation (SMD: -2.294, 95%CI: -4.127~-0.460), and hospital stays (SMD: -1.918, 95%CI: -2.594~-1.242) were lower, but the operation duration (SMD: 1.998, 95%CI: 0.595 ~ 3.401) was greater in the arthroscopy group. After treatment, the Lysholm score (SMD: 1.424, 95%CI: 0.858 ~ 2.837), International Knee Documentation Committee score (SMD: 1.848, 95%CI: 0.858 ~ 2.837), range of motion (SMD: 0.527, 95%CI: 0.001 ~ 1.053) were greater in the arthroscopy group than in the ORIF group, but no statistically significant difference was observed in the pain score (SMD: -0.250, 95%CI: -0.664 ~ 0.165), and posterior drawer test negative rate (OR: 1.040, 95%CI: 0.460 ~ 2.351). Moreover, the incidence of postoperative complications (OR: 0.458, 95%CI: 0.149 ~ 1.411) was not significantly different between the arthroscopy group and the ORIF group.</p> Conclusion <p>Arthroscopic surgery appears to provide better functional outcomes and a comparable risk of complications than ORIF does to some extent, although longer operative time and study heterogeneity warrant caution, for PCL tibial avulsion fracture.</p>