Abstract
We present our long-term results using a modified Chrisman-Snook procedure in 12 consecutive patients over a 4 year period. The minimum follow-up was 1 year.
We used this procedure in patients with symptomatic lateral instability of the ankle, with the index injury being 5 years or more prior to surgery. We believe that poor soft tissue at the site of the ligament rupture precludes an anatomical reconstruction (8 patients). 4 patients had had a previous failed Brostrom reconstruction.
Materials and Methods: 12 patients (10 males:2 females) Age: 32–57 (average 48) All patients had a pre-surgery trial of physiotherapy, proprioceptive exercises and bracing was considered unacceptable.10 patients had pre-surgery MR scans. 10 patients underwent arthroscopy of the ankle at the time of the reconstruction.
Technique: Lateral extensile incision with dorsal half of peroneus brevis used as graft.
Suture anchor in the talus and drill tunnels in the fibula and calcaneum.
Results: AOFAS Preop: 69 (range 60–76) Postop: 92 (range 88–97)11 reported subjective stability, 1 had occasional instability with no objective corroboration. Objectively, 4 had over-tightening with loss of between 20–30% of subtalar movement. There were 2 sural nerve injuries. There were 2 minor wound complications, NOT requiring surgical intervention. All the above complications occurred in the first 6 cases.
Conclusions: We conclude that this is a powerful corrective procedure for chronic lateral ankle instability, but is technically demanding. There are complications in the form of over-tightening and nerve damage which can be minimised with experience.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
