BACKGROUND: Chronic ankle instability (CAI) often requires surgical intervention, but the optimal suturing repair technique remains unclear. This study aimed to compare the clinical efficacy of modified trans augmentation (MTA) suturing repair and trans augmentation (TA) suturing repair to provide a feasible option for patients with CAI and their surgeons. METHODS: This single-center retrospective study included 73 patients with CAI who treated between February 2019 and January 2021. Patients were assigned to MTA or TA groups based on ligament condition. Clinical outcomes were assessed using the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), anterior drawer test, patient satisfaction, and postoperative complications. RESULTS: Postoperative AOFAS scores were significantly higher in the MTA group (91.0 ± 7.1) compared to the TA group (83.3 ± 9.4, P <
0.001). Similarly, patient satisfaction was higher in the MTA group (8.6 ± 0.9 vs. 8.1 ± 1.0, P = 0.02), whereas VAS scores were lower (1.2 ± 0.4 vs. 1.4 ± 0.5, P = 0.01). There were no significant differences in anterior drawer test results between the groups (P = 0.32). CONCLUSIONS: MTA suturing repair demonstrates superior clinical outcomes compared to TA suturing repair, providing a feasible for patients with CAI. These findings highlight the potential of MTA repair to improve patient satisfaction and functional recovery.