Objective To investigate the impact of deltoid ligament reconstruction using suture anchors on multidimensional motor function in patients with ankle fractures combined with ligament injuries. Methods A retrospective cohort study included 210 patients undergoing open reduction and internal fixation （ORIF） for ankle fractures with confirmed DL injuries between March 2023 and March 2024. Based on intraoperative management of the DL， patients were allocated to a reconstruction group （received suture anchor-based DL reconstruction， n = 110； 4 lost to follow-up） or a control group （ORIF alone without DL reconstruction， n = 100； 2 lost to follow-up）. Outcomes assessed preoperatively and at 3， 6， and 12 months postoperatively included： 6DOF ankle motion parameters （internal/external rotation， dorsiflexion/plantarflexion， inversion/eversion， superior/inferior translation， medial/lateral translation， anterior/posterior translation）， American Orthopaedic Foot & Ankle Society （AOFAS） scores， visual analogue scale （VAS） pain scores， and radiographic parameters （medial clear space， talar tilt angle）. Clinical efficacy at 12 months and postoperative complication rates were also compared. Results The reconstruction group demonstrated significantly longer operative times， greater intraoperative blood loss， and longer hospital stays compared to the control group （all P < 0.001）. At 12-month follow-up， the excellent and good rate （based on AOFAS） was significantly higher in the reconstruction group （93.40% vs. 81.63%， P < 0.05）. While all parameters improved significantly over time in both groups， the reconstruction group exhibited significantly greater improvements in all 6DOF motion parameters， higher AOFAS scores， and lower VAS scores at all postoperative time points （all P < 0.001）. Radiographically， the reconstruction group achieved significantly better restoration of the medial clear space and talar tilt angle at all postoperative assessments （all P < 0.001）. Postoperative complication rates did not differ significantly between the groups （P > 0.05）. Conclusion For patients with ankle fractures combined with deltoid ligament injuries， suture anchor-based anatomical reconstruction of the deltoid ligament effectively restores multidirectional ankle kinematics， improves functional outcomes as measured by the AOFAS score， alleviates pain， and facilitates radiographic reduction， without increasing the risk of postoperative complications， thereby representing a safe and effective treatment strategy.