[Objective] To compare the clinical outcomes of intramedullary nailing through infrapatellar approach versus suprapatellar approach for tibial shaft fractures. [Methods] The literatures on comparison of suprapatellar and infrapatellar intramedullary nailing for tibi- al shaft fractures published before August 2021 was searched in databases, including PubMed, EMBASE, Cochrane Library, Wanfang data- base, Weipu database and CNKI. The meta-analysis was conducted by using Review Manager 5.3 software, involving the binary variables, such as fracture malunion, fracture nonunion, postoperative infection, and continuous variables, such as operation time, intraoperative bleeding, location of needle entry point, radiation dose, VAS score and Lysholm score. [Results] A total of 13 literatures were included in the study, involving 1 112 cases of tibial shaft fractures. As consequences of the meta-analysis, the suprapatellar approach proved signifi- cantly superior to the infrapatellar approach in terms of fracture malunion (OR=5.43, 95%CI: 2.16~13.65) , accuracy of nail placement (an- teroposterior MD=1.74, 95%CI: 1.22~2.27 and lateral MD=2.25, 95%CI: 1.35~3.16) , postoperative pain score (MD=0.81, 95%CI: 0.64~ 0.98) and Lysholm score (MD=-5.26, 95%CI: 6.52~4.00) . However, there were no statistically significant differences between the two groups in terms of non-union of fracture (OR=0.95, 95%CI: 0.55~1.65) , postoperative infection (OR=0.62, 95%CI: 0.25~1.57) , intraopera- tive blood loss (MD=0.18, 95%CI: 1.71~2.07) and intraoperative radiation exposure dose (MD=8.72, 95%CI: -6.24~23.68) . [Conclusion] The suprapatellar approach is considerably superior to the infrapatellar approach in reducing fracture malunion, improving accuracy of nail placement, reducing postoperative pain and enhancing function recovery after operation, especially for the proximal and distal tibial shaft fractures.