Abstract:[Objective] To compare the clinical efficacy of arthroscopic reduction and titanium cable internal fixation versus traditionalopen counterpart for patellar fractures. [Methods] A retrospective study was conducted on 59 patients had closed unilateral patellar frac-tures treated surgically in our department from January 2022 to December 2022. According to doctor-patient communication, 31 patients un-derwent arthroscopic reduction and titanium cable internal fixation (the arthroscopic group), while other 28 patients received open reductionand titanium cable internal fixation (the open group). The perioperative, follow-up and imaging data of the two groups were compared. [Re-sults] All the patients in both groups were successfully operated on. The arthroscopic group proved significantly superior to the open group interms of total incision length [(3.5±0.3) cm vs (8.5±0.6) cm, P＜0.001], intraoperative blood loss [(73.5±16.4) ml vs (94.6±21.5) ml, P＜0.001],intraoperative fluoroscopy times [(2.8±0.9) times vs (3.4±1.0) times, P=0.035], hospital stay [(4.3±1.5) day vs (8.3±2.1) days, P＜0.001]. Themean follow-up period was of (15.3±4.4) months, and there was no significant difference in time to resume full weight-bearing activities be-tween the two groups (P＞0.05). The VAS, Kujala and Lysholm scores, as well as knee extension-flexion range of motion (ROM) were signifi-cantly improved in both groups over time postoperatively (P＜0.05). At 12 weeks and the last follow-up, the arthroscopic group was signifi-cantly better than the open group in terms of knee extension-flexion ROM [(105.0±3.9)° vs (100.5±3.9)°, P＜0.001; (117.9±4.8)° vs (112.3±4.4)°, P＜0.001]. Regarding to imaging, the joint surface congruity was significantly improved in both groups at the last follow-up comparedwith that preoperatively (P＜0.05). However, there were no statistically significant differences in the joint face congruity between the twogroups at and corresponding time points (P＞0.05), and fracture healing time between the two groups (P＞0.05). [Conclusion] The arthroscop-ic reduction and titanium cable internal fixation for patellar fractures has the advantages of better safety, less bleeding, shorter operation time, smaller incision, shorter hospital stay and better functional recovery over the open counterpart.