Background: Tibial plateau fractures impact knee stability and function, necessitating effective surgical management. This study compares the clinical and radiological outcomes of Arthroscopically Assisted Reduction and Internal Fixation (ARIF) and Open Reduction and Internal Fixation (ORIF). Methods:We examined 58 tibial plateau fracture patients treated at the NH-R N Tagore International Institute of Cardiac Sciences, Kolkata, from August 2020 to August 2021. knee injury and osteoarthritis outcome scores (KOOS), range of motion, and radiographic criteria such joint congruity and alignment were evaluated. Results:Patients in the ARIF group (n=29) had a substantially higher KOOS (84.3 ± 7.2) than those in the ORIF group (79.1 ± 8.3) (p=0.03). Radiological results favoured ARIF with higher joint congruity and less articular step-off. No substantial difference was found in group complications. Conclusion: ARIF may offer better functional and radiological outcomes for tibial plateau fractures compared to ORIF, suggesting its preference in cases requiring minimally invasive approaches and precise articular reconstruction. Further randomized studies are needed to confirm these findings.