To investigate the effect of arthroscopic reduction and internal fixation of Meyers-McKeever type IV (Meyers IV) anterior cruciate ligament avulsion fracture of tibial intercondylar ridge with double-tie suture bridge. Methods: Nine patients with Meyers IV tibial intercondylar ridge avulsion fractures admitted to hospital from October 2019 to September 2021 were selected. There were 3 males and 6 females with an average age of 42.5 (42.5±3.94) years, ranging from 26 to 52 years. Lesion site: left knee in 16 cases and right knee in 12 cases. Causes of injury: 6 cases of traffic accident, 2 cases of sports injury, and 1 case of sprain. Radiographs showed comminuted and displaced avulsion fractures of the tibial intercondylar crest. The time from injury to operation was 2-11 days, with an average of 6.0 (6.0±1.2) days. The arthroscopic sledge reduction was performed, two non-absorbable sutures were wrapped around the anterior tibial attachment of the anterior cruciate ligament, and the necktie ligature was ligated. Then the crossed sutures were reticulated to form a suture bridge, and the fracture block and the attached tibial insertion of the anterior cruciate ligament were reduced and fixed by traction through the anterior double tunnel of the tibial condyle. Results: All the incisions healed in stage Ⅰ, and no complications such as infection, vascular and nerve injury occurred. All the 9 cases were followed up for 11 to 26 months, with an average of 19 months. Reexamination of radiographs showed that all fractures healed at 8-10 weeks after surgery, with an average of 11 weeks. At the last follow-up, all patients had recovered their pre-injury life and exercise levels. The knee joint was stable without lameness or strangulation. Knee joint extension and flexor range 0 ~ 130°. The Lachman test and the front drawer test were negative. At the last follow-up, IKDC score of knee joint was 90.3 (90.3±2.9) points with a statistically significant difference compared with preoperative score 43.9 (43.9±3.6) points (P = 0.000). Lysholm score was 92.7±2.5 points with a statistically significant difference compared with 32.6±2.2 points before operation t (P = 0.000). Conclusion: The application of double-tie suture bridge reduction and fixation in the treatment of Meyers IV tibial intercondylar ridge avulsion fractures under arthroscopy can effectively fix displaced avulsion comminuted fracture, with large fixation area and even pressure, which is conducive to early functional exercise and can obtain satisfactory efficacy.