Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model

Abstract

Background: Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct. Methods: Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with P < .05 considered significant. Results: Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape ( P < .001). Conclusion: We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability. Clinical Relevance: This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.

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

“…Finally, the model utilized is only the second to increase the ground-reaction force up to loads that simulate those experienced by active patients and athletes, greatly exceeding that applied in most biomechanical models of this injury. 11,17,24,31,32 The data demonstrate that fiber tape and CTC screws provide biomechanical stability in repairing ligamentous Lisfranc injuries while generally withstanding high loads (Figure 4). Three specimens reached 2 mm of diastasis at the MC-2MT joint, which was indicative of failure, with 1 being in the fiber tape group and 2 in the CTC screw group.…”

“…Finally, the model utilized is only the second to increase the ground-reaction force up to loads that simulate those experienced by active patients and athletes, greatly exceeding that applied in most biomechanical models of this injury. 11 , 17 , 24 , 31 , 32 …”

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

“…The tarsometatarsal joint injury represents a series of injuries, ranging from high-energy damages, with severely unstable mid-foot, to low-energy damages, with subtle subluxations or instability without significant displacement. Low energy damages are the most common type, usually accompanied by ligamentous Lisfranc injuries, which are the result of axial, rotational or twisting injuries, especially in sports such as running, jumping and twisting the weightbearing foot [ 4 , 14 – 16 ]. Lisfranc ligament is the most important kind of interosseous ligament, which is a stable structure connecting the medial column and the middle column, and it had a single bundle in 73% and double bundles in 27% of the feet [ 17 ].…”

“…Lisfranc ligament is the most important kind of interosseous ligament, which is a stable structure connecting the medial column and the middle column, and it had a single bundle in 73% and double bundles in 27% of the feet [ 17 ]. Ligamentous Lisfranc injuries are difficult to be found by X-ray because of its unique anatomic location and natural morphology, which leads to the failure diagnosis [ 14 ]. It is the reason for adverse clinical outcomes that patients with purely ligamentous Lisfranc injuries get inappropriate treatment due to misdiagnosis or underestimation of the severity of the injury.…”

Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

“…While randomized clinical studies regarding internal bracing techniques for Lisfranc injuries are lacking, a recent study using 24 cadaveric models comparing suture augmented ligamentplasty with conventional transarticular screws showed equivalent stability with suture augmentation exhibiting less variability. 7 Current literature focuses on athletes with low-energy ligamentous injuries or fractures. [1][2][3][4]9 This is the first case of homolateral fracture/dislocation in a Division 1 varsity athlete successfully returning to sport.…”