Persistent postoperative pain after the Chrisman-Snook ankle reconstruction.

Paul Juliano, J. D. Jordan, F. G. Lippert, T. Craig

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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.

Original languageEnglish (US)
Pages (from-to)449-452
Number of pages4
JournalAmerican journal of orthopedics (Belle Mead, N.J.)
Volume29
Issue number6
Publication statusPublished - Jan 1 2000

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All Science Journal Classification (ASJC) codes

  • Medicine(all)

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