Introduction: Tibial Spine Fracture (TSF) can be treated conservatively for reduced or nondisplaced fractures and surgically for displaced fractures. In recent years, different surgical techniques, especially arthroscopic techniques, have been described to ensure a stable repair and reduce the risk of complications, However, it entails a long learning period and requires complex tools, skills and equipment, but in a country like India with a large population and low economy, such medical facilities are often out of reach.So the authors decided to measure the functional outcomes of Anterior Cruciate Ligament (ACL) Avulsion fracture(tibial spine Avulsion fractures) treated with open reduction and fixation in rural setup. Materials and method - study of 12 patients of anteriortibial spine fracture with ACL tibial Avulsion fractures of type 3(a&b) were included. Patients were approached with Medial Para patellar incisions, open arthrotomyand fracture fragments were identified and reduced and fixation was done using Herbert screw.Follow up and evaluationwas done using Lysholm knee score with minimum duration of 6 months of follow up. Results-Results are assessed based on radiological union, Lysholm knee score and ability to return to daily routine, in which Lysholm knee score of87.2 ±4.2, mean radiological union at 15.6±1.7 weeksand return to daily activity at 16.7 ± 2.4weeks of duration. Conclusion- Open reduction and internal fixation of anterior tibial spine (anterior cruciate ligament) avulsion provides a satisfactory functional outcome, direct visualization of reduction, and stable osteosynthesis which enables early range of motion. it has a less learning curve and cost effective.