title: Treatment of ankle instability in children and adolescents with a modified Chrisman-Snook repair: a clinical and patient-based outcome study.
abstract: Ligamentous injuries to the lateral ankle complex, although rare in the child with open physes, increase with age and are seen with considerable frequency in late childhood and adolescence. In athletic, ligamentously lax individuals, recurrent sprains may lead to ligament attenuation and instability. When instability becomes chronic and interferes with everyday activity, reconstruction is indicated. The literature on reconstruction addresses primarily the adult population, with minimal guidance in treating the child and adolescent. The authors report their experience with 48 reconstructions performed in patients aged 8 to 17 years (mean 14.5 years) over a 12-year period. Mean follow-up was 6.5 years. All patients failed to respond to conservative treatment, including casting or bracing and physical therapy. All had disabling instability. All had a positive drawer sign clinically, and all but one had significant talar tilt on preoperative stress radiographs. A modification of the Chrisman-Snook procedure was used. Forty-four ankles in 38 patients were available for clinical and radiographic re-evaluation. One patient with generalized systemic ligamentous laxity required bilateral repair for failure of previous Evans procedures 8 years earlier; the remaining patients had primary repairs and remain asymptomatic. Each has a negative drawer sign and a reduction of talar tilt from a preoperative average of 14.5 degrees to a postoperative average of 4 degrees, based on stress radiographs. An outcomes questionnaire was administered to all patients, who subjectively rated their pain and instability at extremely low levels (1/10) and their function at a high level (8/10). All patients had their expectations met regarding the results of surgery. There was no radiographic evidence of degenerative arthritis at follow-up. The authors recommend this as an excellent means of treating children with chronic ankle instability who have failed to respond to conservative treatment. The authors have modified Chrisman's procedure by using a much smaller incision and improved graft isometry.
authors.affiliation: Department of Pediatric Orthopedic Surgery, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Marsh
authors.forename: John P
authors.initials: JP
authors.lastname: Daigneault
authors.forename: Gert K
authors.initials: GK
authors.lastname: Polzhofer
mesh_terms: D000293:Adolescent; D000843:Ankle Joint; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome