Abstract:[Objective] To compare the clinical outcomes of anchor suture reconstruction versus screw fixation for inferior tibiofibular syndesmosis injury (ITSI) . [Methods] From March 2019 to June 2020, a total of 64 patients received surgical treatment for ankle fractures accompanied with ITSI in our hospital. The patients were randomly divided into two groups by lottery, including 32 patients who underwent anchor suture reconstruction, while the other 32 patients who had screw fixation for the ITSI after fracture fixation. The clinical and imaging data of the two groups were compared. [Results] All patients had surgical procedures performed smoothly, with no significant differences in operative time, incision length, number of fluoroscopy and intraoperative blood loss between the two groups (P＞0.05) . All patients were fol- lowed up for more than 12 months, and the reconstruction group resumed weight- bearing activity significantly earlier than the fixation group (P＜0.05) . The extension-flexion ankle range of motion (ROM) and AOFAS scores in both groups improved significantly over time (P＜ 0.05) , which in the reconstruction group were significantly superior to those in the fixation group at 3 months postoperatively (P＜0.05) , whereas became not statistically significant between them at 6 months after operation and the latest follow-up (P＞0.05) . Radiographically, tibiofibular clear space (TFCS) and medial clear space (MCS) significantly decreased, while the tibiofibular overlap (TFO) significantly in- creased in both groups at the latest follow up compared with those preoperatively (P＜0.05) . However, there were no significant differences in the above imaging items between the two groups at any matching time points (P＞0.05) . [Conclusion] Both anchor suture reconstruction and screw fixation do effectively treat ITSI, by comparison, the former has the advantages of early weight bearing and faster functional recov- ery.