Forty patients with displaced tibial-sided posterior cruciate ligament (PCL) avulsion fractures were randomized to undergo arthroscopic reduction and internal fixation (ARIF) by arthroscopic double-tunnel suture fixation (n=20) or an open reduction and internal fixation (ORIF) via cancellous screw fixation (n=20). Outcomes of interest included functional capacity, cost of surgery, length of surgery, hospital stay, incidence of non-union, and incidence of posterior tibial displacement. Results revealed that cost of surgery and length of surgery were significantly lower in the ORIF group vs ARIF group (p<0.05 for both). However, all other outcomes were not significantly different between the 2 groups (p>0.05 for all). 2 patients reported malunion in the ARIF group vs. 0 patients in the ORIF group; 12 patients in the ORIF group and 9 patients in the ARIF group reported a posterior tibial displacement of 5-10 mm.