Abstract: [Objective] To compare the postoperative complications and the effect of surgery of the suprapatellar approach and transpatellar approach for the treatment of fracture of shaft of tibia with intramedullary nails. [Methods] Seven domestic and foreign databases were searched. Meta-analysis was carried out after literature screening and data extraction. [Results] A total of 11 randomized controlled trials were included. The results showed that the operation time of the two operative approachs was comparable (P＞0.05), and the intraoperative blood loss of the two operative approachs was comparable (P＞0.05), the hospital stay of the two operative approachs was comparable (P＞0.05), and the fracture healing time of the two operative approachs was comparable (P＞0.05). However, the incidence of postoperative knee pain of suprapatellar approach was lower than that of the transpatellar approach (P＜0.05). The long-term Lysholm knee score of the suprapatellar approach was higher than that of the transpatellar approach (P＜0.05). The long-term HSS knee score of the suprapatellar approach was higher than that of the transpatellar approach (P＜0.05). [Conclusions] There was no significant difference in the operation time, intraoperative blood loss, hospital stay and fracture healing time between the suprapatellar approach and the transpatellar approach for the treatment of fracture of shaft of tibia, but the incidence of postoperative knee pain of the suprapatellar approach was smaller. The postoperative knee function recovery of the suprapatellar approach was better. Moreover, the above conclusion need to be confirmed by the more comprehensive high-quality randomized controlled trial.