Modified Chrisman-Snook repair for the treatment of chronic ankle ligamentous instability in children and adolescents

Abstract

Purpose: Chronic ankle ligamentous instability is not uncommonly encountered in children and adolescents. A number of operative procedures have been developed and described in the literature, including variations on the original Chrisman-Snook (CS) repair. The purpose of this study is to describe a modification of the CS repair and report the outcomes of this surgery for the treatment of chronic ankle ligamentous instability in children and adolescents.

Methods: A retrospective review was conducted of 100 consecutive surgeries in 66 children performed by a single surgeon who modified the CS repair using a split peroneus brevis tendon to reinforce the anterior talofibular and calcaneofibular ligaments in chronic ligamentously lax patients. All charts were reviewed for complications. Fifty-three cases had at least a 2-year follow-up and were evaluated for the following outcomes: return to activity, ligamentous laxity, pain, and subsequent sprains.

Results: Of the 100 surgeries performed, no patient required repeat ligamentous repair. There were no deep wound infections. There were 10 cases of minor wound healing problems and two cases of temporary nerve dysfunction, one of which resolved without surgical intervention and the other is resolving with no plans for surgical intervention. There were two cases of sural nerve branch entrapment which required subsequent surgery due to neuroma formation. Of the 53 cases with at least a 2-year follow-up, the following outcomes were obtained: all patients returned to full activities of their choice; all but one case maintained ≤45° of ankle inversion postoperatively; all patients were pain free or had only occasional discomfort; and 23% of the ankles experienced subsequent minor sprains, but all were minor and resolved without consequence.

Conclusions: A modification of the CS repair where the split peroneus brevis tendon is used to create ankle stability has been routinely successful in 100 consecutive cases of chronic ligamentous instability in children and adolescents with very few complications.

Keywords: Ankle instability; Children; Modified Chrisman–Snook repair.

Fig. 1

Lace-up gauntlet brace

Fig. 2

Drawing of surgical incision

Fig. 3

Drawing and operative photograph of peroneus brevis tendon splitting

Fig. 4

Drawing and operative photograph of tunnel beneath sinus tarsi and extensor digitorum

Fig. 5

Drawing and operative photograph of fibular drilling

Fig. 6

Drawing and operative photograph of split peroneus brevis tendon brought through the lateral subperiosteal tunnel along the lateral wall of the os calcis, eventually reaching the distal attachment on the fifth metatarsal

Fig. 7

Operative photograph of sutures

Fig. 8

Drawing of complete surgery