A randomized controlled trial investigated whether the deltoid ligament augmentation (DLA) could replace trans-syndesmotic screw fixation (TSSF).  Study design and results The  study  enrolled 59 patients, including 30 receiving DLA and 29 receiving TSSF, and followed them for one year. The AOFAS score was the primary outcome measure.  Key findings: At one year, both approaches produced equivalent AOFAS scores. At three months, the DLA group showed better AOFAS scores and bet