Lateral ankle stabilization. Modified Lee and Chrisman-Snook

Abstract

Chronic lateral ankle instability is not always a severe disability, but surgical reconstruction may be necessary in patients with instability or when conservative measures fail. Although recent articles by Ahlgren and Larsson and Bergsten et al provide evidence of satisfactory results with late ligamentous repair of chronic ankle instability via imbrication, lateral ankle stabilization procedures that use tenodesing of fasciodesing techniques continue to provide good results. Prolonged disability after acute lateral ankle ligament disruption has been reported in 20% of patients. With long-term instability, uneven stress distribution with recurrent sprains can lead to osteoarthritis. Various methods for evaluation of the chronically unstable ankle include inversion stress testing, anterior drawer sign, arthrography, and tenography. All of these methods are controversial with false negative results, unreliability, and variations in measurements and interpretation being cited. With this in mind, radiographic instability must be correlated with mechanical and clinical instability. Once all of these findings are correlated the physician can determine the appropriate procedure that will provide the patient with long-term stability. Although more recent studies have addressed repair of chronic instability with ligamentous reinforcement or imbrication, these procedures remain controversial in lieu of Freeman's deafferentiation theory with loss of proprioception. There is also mechanical instability of the subtalar joint, which may also require stabilization. Use of the modified Lee and the Chrisman-Snook techniques as described have provided good results.