Flexible fixation for ligamentous lisfranc injuries

Briceño, Jorge; Stupay, Kristen L.; Moura, Bruno; Velasco, Brian; Kwon, John Y.

doi:10.1016/j.injury.2019.07.024

Cited by 11 publications

(9 citation statements)

References 19 publications

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“…Firstly, a large amount of cartilage was removed in primary arthrodesis, so that the articular surface was almost completely destroyed [ 21 ]. Additionally, the loss of mobility of the first tarsometatarsal joint would lead to compensatory hypermobility and adjacent joint sclerosis [ 6 ]. Reinhardt et al [ 22 ] in their investigation suggested that a 12% rate of adjacent joint arthritis in a group of 25 patients who were followed for 42 months after primary fusion.…”

Section: Discussionmentioning

confidence: 99%

“…Ligamentous Lisfranc injuries require extensive surgical intervention, including closed/open reduction with percutaneous puncture, open reduction and internal fixation, and primary arthrodesis. However, the tarsometatarsal joint is one of the amphiarthrosis and limitations of rigid fixation include iatrogenic articular cartilage injury, implant fracture and the need to remove implants [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries

et al. 2021

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Background Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation. Methods We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up. Results The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values (P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation. Conclusion Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries

et al. 2021

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“…The included clinical studies are summarized in Tables 1 and 2. The mean MINORS score of the 11 studies was 8.9 (range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Open reduction was performed in 8 studies, [6][7][8][9]11,18,23,35 with 1 study 33 reporting percutaneous reduction and 2 studies 14,25 not specifying.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…2,34 The optimal fixation strategy for the subset of Lisfranc injuries without concomitant fracture, pure ligamentous, is as of yet unknown. 1,5,6,18,25,30 Traditionally, operative treatment for stabilization of the affected joint has been performed by direct or indirect reduction followed by fixation with a "home run screw," which may range in size from 3.0 to 4.5 mm. This strategy effectively stabilizes the midfoot but has also been associated with damage to articular cartilage, hardware failure, and need for eventual hardware removal.…”

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confidence: 99%

Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis

Chona,

Park,

Kim

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear. Purpose: To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed. Results: Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs –0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load. Conclusion: Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.

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“…Cottom et al 64 described 3 cases using a suture Endobutton technique with satisfactory short-term results. Briceno et al 65 described a repair technique utilizing FiberWire suture tired around screw posts, and Delman et al 66 described a ligament reinforcement technique using the Arthrex InternalBrace. Charlton et al 67 described the use of a suture button repair of chronic injuries in high-level dancers and athletes with good success.…”

Section: Flexible Fixationmentioning

confidence: 99%

The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management

Jie

Sagoo

Panchbhavi

2020

Foot & Ankle Specialist

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Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. This article reviews the literature from established and classic papers to recent studies evaluating newer techniques. We discuss the unique bony and ligamentous anatomy, which confer strength to the Lisfranc complex, the typical mechanisms of injury, the most common classification systems, the clinical presentation, current imaging modalities, and conservative and surgical treatment options. We review studies comparing open reduction and internal fixation with primary arthrodesis of acute injuries, in addition to studies evaluating the various methods for obtaining fixation, including intra-articular screws, dorsal plates, and flexible fixation. It is clear from this review that despite the vast number of studies in the literature, much is still to be learned about the diagnosis and management of this challenging injury. Levels of Evidence: Level V: Expert opinion

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Flexible fixation for ligamentous lisfranc injuries

Cited by 11 publications

References 19 publications

Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries

Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries

Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis

The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management

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