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

Fan, Yongfei; Liu, Chao-Yu; Wang, Xu; Ma, Xinlong; Xu, Jie; Wang, Wei

doi:10.1186/s12893-021-01394-x

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…Patient-reported outcome according to the AOFAS improved from 31 at the time of injury to 90 postoperatively. Supportive data from small retrospective series including both acute 73,74 and chronic injuries 75 have been reported. Concerns regarding fixation purchase in poor-quality bone limit the indication of these implants to younger patients with purely ligamentous injuries, and there are currently no level 1 data to support use.…”

Section: Treatmentmentioning

confidence: 79%

Management of Lisfranc Injuries

et al. 2023

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There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations.Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury.Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries.Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area.We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.

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Section: Treatmentmentioning

confidence: 79%

Management of Lisfranc Injuries

et al. 2023

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“…AOFAS scores were pooled from 6 studies, [7][8][9]11,23,35 with a mean score among 150 patients of 90.1 at a mean time of 30.7 months; this indicates an excellent result. 10 VAS scores were reported in 5 studies, 8,11,18,23,35 and among the 137 patients, the mean score was 1.5 at a time of 30.8 months; this is consistent with minimal or no pain. 17,24 Cho et al 8 found significantly inferior clinical outcomes associated with conventional screw fixation in comparison with suture button fixation.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…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. All studies used the Mini TightRope (Arthrex) between the medial cuneiform and second metatarsal for fixation.…”

Section: Clinical Studiesmentioning

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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“…14 Anatomic reconstruction of the Lisfranc ligament is a possible treatment option for acute Lisfranc ligament injury. 8,17,34 For this purpose, MRI is useful to know the condition of the Lisfranc, dorsal, and plantar ligaments in the acute phase of injury. If open reduction and screw fixation or primary arthrodesis were selected for operative management, MRI was not indicated for diagnosis of acute Lisfranc injury.…”

Section: Discussionmentioning

confidence: 99%

“…13,33 Anatomical reconstruction of the Lisfranc ligament has been developed as an alternative operative procedure for Lisfranc ligament injury. 8,17,34 Direct observation of the degree of injury of the Lisfranc ligament, the dorsal ligament, and the interosseous C1-C2 ligament is performed during surgery. 8 Precise diagnosis of these ligament injuries is important to select the best treatment option.…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations

Kitsukawa

Hirano

Niki

et al. 2022

Foot & Ankle Orthopaedics

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Background: Early diagnosis is important in patients with Lisfranc joint injury to avoid subsequent complications. As the ligaments in the Lisfranc joint are relatively small and course obliquely, isotropic 3-dimensional (3D) magnetic resonance imaging (MRI) can be beneficial to evaluate ligament injury. The purpose of this study was to investigate the diagnostic accuracy of MRI, including isotropic 3D MRI for acute injury of the Lisfranc joint, especially of the interosseous C1-M2 ligament (Lisfranc ligament), the dorsal C1-M2 ligament (dorsal ligament), and the interosseous C1-C2 ligament, compared with direct operative observations. Methods: This retrospective review identified 27 patients who had undergone MR examination for acute Lisfranc joint injury followed by surgery. We reviewed the operative reports that described the Lisfranc, dorsal, and interosseous C1-C2 ligaments. All patients underwent an MRI, including a 2D oblique plane image parallel to the Lisfranc ligament and an isotropic 3D MRI. An image analysis of the integrity of the 3 ligaments and other associated injuries was performed. The diagnostic accuracy of MRI was analyzed using operative findings as a reference standard. Results: Lisfranc and dorsal ligament injuries were identified on MRI in all patients. MRI depicted disruption of the interosseous C1-C2 ligament in 12 patients. MRI diagnostic accuracy for detection of Lisfranc, dorsal, and interosseous C1-C2 ligaments was 100% (95% CI 0.82-1.0), 74% (95% CI 0.54-0.89), and 70% (95% CI 0.50-0.86), respectively. Conclusion: MRI with oblique planes parallel to the Lisfranc ligament and isotropic 3D MRI was reliable for detecting Lisfranc ligament injury, whereas MRI findings of the dorsal and interosseous C1-C2 ligaments were less consistent with operative observations. Level of Evidence: Level IV, case series.

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

Cited by 11 publications

References 32 publications

Management of Lisfranc Injuries

Management of Lisfranc Injuries

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

The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations

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