Abstract
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. 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. 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. 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.
Highlights
Chronic ankle ligamentous instability is not uncommonly encountered in children and adolescents
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
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
Summary
Chronic ankle ligamentous instability is not uncommonly encountered in children and adolescents. Ligamentous insufficiency may occur as the result of undiagnosed avulsion fractures of the bony or cartilaginous insertion of the anterior talofibular ligament (ATFL). Avulsion fractures at the distal apex of the lateral malleolus are not always visible on plain radiographs. Such ligamentous injuries could eventually lead to chronic lateral instability of the ankle [2]. Chronic ankle ligamentous instability is seen most commonly in association with generalized ligamentous laxity where ankle sprains readily occur with minor or major ankle twisting. The ligamentous laxity predisposes the patient to chronic sprains
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