title: Persistent postoperative pain after the Chrisman-Snook ankle reconstruction.
abstract: One complication of the Chrisman-Snook ankle reconstruction is persistent postoperative pain. The incidence of this complication ranges from 7% to 60%. We report 10 cases of surgical exploration for persistent pain after Chrisman-Snook reconstructions. In 6 of the 10 cases a surgically correctable cause was found for the pain. The identified pathologic lesions in these 6 patients could have been prevented by careful attention to detail in the index operation. Surgical exploration should be considered for any of the following findings: persistent point tenderness (especially at the graft tunnel sites), localized swelling, a painful mass, recurrent instability/laxity, a symptomatic neuroma, or painful inversion and dorsiflexion. To prevent the complication of persistent postoperative pain after the Chrisman-Snook ankle reconstruction, we recommend the following: 1) avoid forced eversion when tensioning the graft, excessive posterior placement of the calcaneal tunnel, casting in eversion, and the use of nonabsorbable suture; 2) resect the distal muscle belly of the peroneus brevis muscle distal to the superior peroneal retinaculum; 3) check for tears in the peroneus brevis; 4) respect the sural nerve; and 5) obtain a watertight closure of the joint capsule. Although the Chrisman-Snook ankle reconstruction is an excellent technique, numerous pitfalls in surgical technique must be avoided.
authors.affiliation: Penn State College of Medicine, and Uniformed Services University of the Health Sciences, Hershey, Pennsylvania, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Juliano
authors.forename: J D
authors.initials: JD
authors.lastname: Jordan
authors.forename: F G
authors.initials: FG
authors.lastname: Lippert
authors.forename: T
authors.initials: T
authors.lastname: Craig
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013180:Sprains and Strains / Q000601:surgery*