Laxity and flexibility of the ankle following reconstruction with the Chrisman‐Snook procedure

Abstract

The effect of reconstruction of the anterior talofibular ligament with the Chrisman-Snook procedure on neutral zone laxity (anterior-posterior displacement at low loads) and flexibility (a measure of the nonlinear load-displacement response) of the ankle was investigated in vitro during the anterior drawer test. Neutral zone laxity was defined as the magnitude of anterior-posterior displacement of the ankle joint at +/- 2.5 N of applied load. The flexibility parameter was defined as the slope of a line between the natural logarithm of the anterior load applied to the ankle and the resulting displacement. After reconstruction with the Chrisman-Snook procedure, the values for neutral zone laxity of the ankle were significantly less than normal at 0 degree of plantar flexion, whereas the flexibility values were significantly greater than normal. This study revealed that, after the Chrisman-Snook procedure, values for ankle flexibility are not restored to normal even if those for neutral zone laxity are reduced to less than normal. The findings suggest that this nonanatomical reconstruction procedure does not reproduce normal kinematics of the ankle joint. This may help explain some of the adverse clinical reports associated with the Chrisman-Snook reconstruction procedure.

Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study

“…Most of these studies report that a tendon transfer procedure limits the range of ankle motion and prevents neither anterior talar translation nor talar tilt [3,23,30,33,44]. Most of these studies report that a tendon transfer procedure limits the range of ankle motion and prevents neither anterior talar translation nor talar tilt [3,23,30,33,44].…”

“…This impaction force explains the cartilage damage which can subsequently lead to degenerative changes[3,12,23, 30,33,39,44, 46]. It has been demonstrated that in supination trauma cartilage damage occurs in 65% at the medial talar facet and tip of the medial malleolus[46].…”

Lateral Ankle Instability and Revision Surgery Alternatives in the Athlete

“…1,[18][19][20][21][48][49][50][51][52][53][54] Use of an anatomic reconstruction has replaced the historical tenodesis procedures such as the Evans, Watson-Jones, Chrisman-Snook, and others that have been shown anatomically and in long-term clinical studies to limit subtalar motion. 8,16,17,22,[55][56][57][58][59][60][61][62][63] In the authors' experience, mistakes in harvesting involve difficulty in isolating the tendon (approach) and amputating the tendon short. The type of anesthetic used in conjunction with this procedure is important.…”

Brostrom-Gould Lateral Ankle Ligament Reconstruction With Suture Bridge Modification

“…1 These patients frequently require surgical intervention, most commonly in the form of a Brostrom-Gould lateral ankle ligament reconstruction. [12][13][14][15] They are primarily reserved for patients with generalized ligamentous laxity, heavy patients, or for revision cases. [8][9][10][11] These techniques tend to produce stiffness, scarring, can result in nerve injury, and can eventually lead to degenerative changes of the ankle and subtalar joints.…”