Percutaneous Inferior Extensor Retinaculum Augmentation Technique for Chronic Ankle Instability.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Ankle Reconstruction

Background:

• Chronic ankle instability often results from attenuated ligamentous tissue.
• Existing treatments may not fully restore ankle stability or function.
• The percutaneous inferior extensor retinaculum augmentation (PIERA) technique offers a minimally invasive approach.

Purpose of the Study:

• To define the indications and contraindications for the modified PIERA technique.
• To detail the surgical technique for PIERA.
• To evaluate the surgical outcomes and complication rates of the PIERA technique in chronic ankle instability.

Main Methods:

• A retrospective case series of seven patients with chronic ankle instability undergoing the modified PIERA technique.
• Preoperative ankle MRI confirmed attenuated ligamentous tissue.
• Inferior extensor retinaculum (IER) augmentation using suture anchors with the ankle in neutral position.
• Functional outcomes assessed using American Orthopaedic Foot and Ankle Society (AOFAS) and Cumberland Ankle Instability Tool (CAIT) scores pre- and postoperatively.

Main Results:

• Significant improvements in mean AOFAS scores (66.9 to 93.7) and CAIT scores (13.1 to 26.3) were observed (P < 0.001).
• Mean follow-up was 16.7 months.
• No major complications like wound healing problems or instability were reported; one patient experienced minor pain and stiffness.
• All patients returned to at least recreational sports.

Conclusions:

• The modified PIERA technique is a viable option for improving functional outcomes in chronic ankle instability.
• The procedure is associated with a low complication rate.
• PIERA effectively restores ankle stability and allows return to activity.