Objective: To introduce the surgical technique and preliminary clinical results of three-line cross-linking pull-out and fixation of anterior cruciate ligament (ACL) tibial avulsion fractures under the microscope. Methods: A total of 36 patients with ACL tibial avulsion fractures (Meyer-McKeevers classification II-IV) from January 2016 to June 2018 in Xi'an Honghui Hospital were retrospectively analyzed. The diagnosis was confirmed under the standard anterolateral knee approach. The lumbar puncture needle with PDS thread was inserted into the joint cavity through the posteromedial skin of the knee joint, and the Ethibond No. 2 wire was introduced after passing through the ACL. Then the Ethibond No. 2 wire was led through the subcutaneous tunnel of the anterior tibial clivus to the anterior medial tibia. The bone tunnel was drilled at the medial and lateral borders of the fracture, and the lumbar puncture needle with Ethibond 2 wire was passed through the far medial skin across the PDS wire loop through the medial and lateral tunnels, and the ACL ligament. Then, a lumbar puncture needle with Ethibond No. 2 wire was used to pass through the inner and outer tunnel PDS loops through the far medial skin in turn, and the three Ethibond No. 2 wire were tightened and fixed with the outer row of anchors. Results: All patients successfully completed the operation. There were no internal fixation failure cases, and the knee joint was stable. 3 months after surgery, X-ray films showed complete fracture healing. At last follow-up, the knee joint function scores were significantly improved compared with those before operation. Conclusions: The three-line cross-linking pull-out technique under the microscope is simple and safe for the reduction and fixation of anterior cruciate ligament tibial avulsion fractures under direct vision. The knee joint function recovers well after surgery, and the internal fixator is removed without the need for secondary surgery. The clinical effect of this surgery is significant.