SLR - January 2023 - Harrison Gilley, DPM PGY-1
Title: Percutaneous Inferior Extensor Retinaculum Augmentation Technique for Chronic Ankle InstabilityReference: Cao S, Wang C, Wang X, Ma X. Percutaneous Inferior Extensor Retinaculum Augmentation Technique for Chronic Ankle Instability. Orthop Surg. 2022 May;14(5):977-983. doi: 10.1111/os.13248. Epub 2022 Apr 18. PMID: 35434967; PMCID: PMC9087451.
Level of Evidence: 3
Reviewed By: Harrison Gilley, DPM PGY-1
Residency Program: SSM DePaul Hospital
Podiatric Significance: Chronic ankle instability is a very common dealt with by podiatrists. There are many different approaches to treating the disease including both conservative therapy and surgery. This retrospective study examines a percutaneous extensor retinacula repair for the treatment of chronic ankle instability. The percutaneous approach is much more convenient than a traditional Brostom-Gould and could potentially pave the way for surgical treatment of chronic ankle instability in the future.
Methods: The percutaneous extensor retinaculum augmentation technique was performed four females and three males aged 15.1 to 36.4 years of age. Each patient had chronic ankle instability over the course of 33.7 +/- 8.8 months. All patients demonstrated attenuated ligamentous tissue quality, which was confirmed using preoperative ankle MRI. Pre and Post-operative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) score and Cumberland Ankle Instability Tool (CAIT) were used to evaluate the patient’s outcomes. Preoperative and postoperative outcome scores of patients were compared using paired t-test. A p value of less than 0.05 was regarded statistically significant.
Results: The mean AOFAS score significantly improved from 66.9 +/- 11.2 preoperatively to 93.7 +/- 8.5 postoperatively (P = 0.001) and a mean CAIT score significantly improved from 13.1 +/- 4.7 preoperatively to 26.3 +/- 1.8 postoperatively (P = 0.001). The mean follow up duration was 15.7 +/- 1.6 months. Patients did not report any complications at the last follow-up examination, except for one patient who reported pain and minimal stiffness, and presented an AOFAS score of less than 80 and a CAIT score below 24.
Conclusion: The PIERA technique can improve the functional outcomes of patients with CAI with few complications. Further studies could be indicated to directly compare post operative outcomes and surgical times with traditional surgeries for CAI.