Anatomic Modified Chrisman-Snook Reconstruction Adam G. Miller, MD Jamal Ahmad, MD Steven M. Raikin, MD American Orthopaedic Foot & Ankle Society Summer 2012
Disclosure Anatomic Modified Chrisman-Snook Reconstruction Adam Miller, Jamal Ahmad, Steven Raikin Our disclosures are in the Final AOFAS Program Book. We have no potential conflicts with this presentation.
Anatomic (Brostrom) reconstruction 1 Pitfalls 2 Failure rates of up to 10% Depends on local tissue quality Non-anatomic (i.e., Chrisman Snook) reconstruction with autogenous peroneal tendon 3,4 Pitfalls 5 Surgical Options for Chronic Instability Subtalar stiffness Non anatomic Decreased peroneal strength Wound complications
Modified Anatomic Tendon Allograft Technique Talar footprint of the ATFL prepared and bone tunnel created (1) 3 2 1 Fibular bone tunnel from ATFL insertion - exiting between the PTFL & CFL insertion (2) Calcaneal bone tunnel between PTFL & CFL attachment (3)
Surgical Technique Semitendenosis Allograft passed through talar tunnel and fixed with interference screw. Allograft passed through fibular bone tunnel (without fixation) Allograft pulled from lateral to medial into calcaneal tunnel and pulled to optimal tension. Graft anchored into calcaneal with interference screw under tension. Peroneal tendons were left intact
Methods 38 patients underwent an Anatomic Modified CS Reconstruction 2 Surgeon series (JA & SMR) between 2001-2011 31 available for follow-up Outcome Scores Foot and Ankle Ability Measure (FAAM) 6 Visual Analog Scale (VAS) for Pain Satisfaction ratings Total Patients 31 Age* (yr) 50 (16-81) Follow-up* (mo) 31 (6-78) Female/Male 16/15 Previous Instability Surgery 12 Left/Right Ankle 12/19 Complications 7 * Mean and range reported
Indication in this study Recurrent deformity - previous Brostrom 9 Per Brevis non anatomic reconstruction 4 Poor tissue quality Ehlers Danlos syndrome 4 Severe deformity >30 varus 5 Associated Varus deformity 12
Results Pre-Surgical Post-Surgical FAAM* VAS Pain Score* 8 41.67 1 95.24 95% CI for Difference 5.00-7.99 40.48-55.95 P-Value <0.001 <0.001 *Mann-Whitney medians reported 91% success rates without recurrence of instability 28 out of 31 patients with good-excellent satisfaction No patients developed subtalar arthritis
Complications 3 poor results (9%) 3 with recurrent instability 1 also developed complex regional pain syndrome (CRPS) Minor complications 3 patients with incisional parathesias
An anatomic modification of the Chrisman- Snook reconstruction with tendon allograft is highly successful in treating severe and recurrent chronic lateral ankle ligament instability REFERENCES Conclusions 1. Brostrom L. Sprained ankles V. Treatment and prognosis in recent ligament ruptures. Acta Chirurgica Scandinavica 1966;132(5):537 50. 2. Krips R, Brandsson S, Swensson C, van Dijk CN, Karlsson J. Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle. Clinical and radiological findings after follow-up for 15 to 30 years. Journal of Bone and Joint Surgery - British Volume 2002;84(2):232 6. 3. Chrisman OD, Snook GA. Reconstruction of lateral ligament tears of the ankle. An experimental study and 4. clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. Journal of Bone and Joint Surgery - American Volume 1969;51(5):904 12. 5. Evans DL. Recurrent dislocation of the ankle: a method of surgical treatment. Proceedings of the Royal Society of Medicine 1953;46:343 4. 6. Baumhauer JF, O'Brien T. Surgical Considerations in the Treatment of Ankle Instability. J Athl Train. 2002 Dec;37(4):458-462. 7. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005 Nov;26(11):968-83.