Ming Lai, Zelin Huang, Wei Zhao, Lilu Peng, Y. Liu, Penglei Yan
To systematically compare the efficacy and safety of arthroscopy-assisted reduction and percutaneous internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for Schatzker type I-III tibial plateau fractures. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and CNKI up to November 2025. Randomized controlled trials (RCTs) comparing ARIF with ORIF were included. Data on functional outcomes and complication rates were extracted and pooled using random-effects models. The Cochrane Risk of Bias tool and GRADE approach were used for quality assessment. Eighteen RCTs involving 1, 346 patients were included. Pooled analysis demonstrated that ARIF was associated with significantly superior excellent-good functional outcomes (OR = 3.14, 95%CI: 2.02–4.88, p < 0.001) and substantially reduced perioperative complication rates (OR = 0.27, 95%CI: 0.18–0.40, p < 0.001) compared to ORIF. For Schatzker type I-III tibial plateau fractures, ARIF provides superior functional recovery and significantly lower complication rates compared to ORIF. As a result, ARIF represents a favorable treatment option for these fracture patterns.