Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Abstract

Background: The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. Purpose: To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint). Results: There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. Conclusion: The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. Clinical Relevance: Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

Early Outcomes of Lisfranc Injuries Treated with Arthrex InternalBrace: A Case Series

“…The first paper compared IB alone with IB with supplemental limbs across the intercuneiform joint in a cadaver model. The second was a cadaver study comparing the InternalBrace (IB) load to failure against screw fixation [ 3 , 11 ]. In these publications, the investigators found that the load to failure was greater if the additional limb was added.…”

“…As a result, the true incidence of these fractures may be underestimated [ 2 ]. Signs and symptoms of low-energy Lisfranc injuries may not be as obvious as high-energy injuries but can include severe pain, inability to bear weight, medial plantar bruising, swelling to the affected tarsometatarsal (TMT) joints [ 3 ]. Dorsal subluxation during application of a dorsal force to the forefoot while the other hand palpates the tarsometatarsal joints is suggestive of global instability [ 3 ].…”

X-Shaped Knot Fixation and Double Posteromedial Portals for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fractures With Retention of the Posterior Septum

“…There is a study that shows that the FiberTape device may serve as a viable alternative to screw fixation, while obviating the need for hardware removal. 15 …”

What’s New in Foot and Ankle Surgery

“…Lisfranc Injuries Koroneos et al 32 performed a cadaveric biomechanical study comparing suture tape fixation including a dorsal intercuneiform limb (n = 8) and traditional cannulated screws (n = 8) for the fixation of ligamentous Lisfranc injuries. No significant differences were found in gapping at the Lisfranc articulation or the intercuneiform articulation.…”