Abstract: [Objective] To compare the therapeutic effect of open reduction and internal fixation combined with or without suture anchor in repairing the deltoid ligament for ankle fracture with medial injury. [Methods] A retrospective analysis was performed on 76 patients with ankle deltoid ligament fracture admitted to our hospital from January 2015 to December 2020. Based on the results of preoperative doctor-patient communication, the patients were divided into two groups. Among them, 38 patients underwent ORIF for fractures combined with deltoid ligment repaired, while the remaining 38 patients had ORIF only without deltoid ligament repaired. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 78 patients had operation completed successfully without serious complications. The repaired group was significantly greater than the unrepaired group in term of operation time, total incision length, and intraoperative blood loss (P<0.05), but the length of hospital stay and time of fracture union were significantly earlier than those in the unrepaired group(P<0.05). All patients were followed up for 12-28 months, with an average of (18.72±4.62) months.Two patients in the unrepaired group underwent revision ankle arthroplasty due to pain and dysfunction. The patients in the repair group recovered to full weight bearing significantly earlier than those in the unrepaired group (P<0.05). The VAS score decreased significantly (P<0.05), while the AOFAS score and ankle dorsiflexion-plantar flexion ROM and ankle and foot varus-valgus ROM increased significantly over time postoperatively in both groups (P<0.05). However, the repaired group had proved significantly superior to the unrepaired group at the corresponding time point in the AOFAS scores, ankle dorsiflexion-plantar flexion ROM and ankle and foot varus-valgus ROM (P<0.05), despite of the fact that the repaired group had significantly less VAS scores than the unrepaired group (P<0.05). MCS and TT in the repaired group were significantly lower than those in the unrepaired group at the last follow-up (P<0.05). TT angles of all patients in the repair group were corrected to normal Angle (≤4°), while those of 6 patients in the non-repair group were not corrected to normal Angle (P<0.05). [Conclusion] The suture anchor repairing is beneficial to improve the clinical outcomes of surgical treatment for ankle fracture with deltoid ligament injury