[Objective] To compare and analyze the clinical effect of total arthroscopic anchor and cannulated screw fixation in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL). [Methods] 84 patients with avulsion fracture of ACL tibia due to total arthroscopic fixation and repair in our hospital from June 2012 to June 2018 were retrospectively analyzed, including 44 cases ( anchor group) were fixed and repaired with anchor, aged 10 ~ 52 years, with an average of (25.42 ± 10.51) years; 40 cases (screw group) were fixed and repaired with cannulated screws, aged from 12 to 55 years, with an average of (27.28 ± 9.34) years. The operation time, combined meniscus injury and walking time were recorded. The postoperative joint relaxation and the knee score of Tegner, Lysholm and IKDC were followed up and evaluated. [Results] 84 patients were followed up successfully for more than 18 months. The time of walking and full weight-bearing activities in the anchor group were shorter than those in the screw group, and the difference was statistically significant (P < 0.05). The scores of knee joints in both groups increased significantly with the extension of time, and there was significant difference between different time points (P < 0.05); Three months after operation, the knee joint scores in the anchor group were better than those in the screw group (P < 0.05); There was no significant difference between the two groups at other time points (P > 0.05). The reoperation rate of anchor group was significantly lower than that of screw group (P < 0.05). During the follow-up, there were no internal fixation loosening, infection and other complications in both groups. [Conclusion] Both surgical methods have achieved good clinical results, Compared with cannulated screw fixation, row anchor fixation has the advantages of short fracture healing time, better early curative effect and significantly lower secondary operation rate.