Radiographic Outcomes of Lisfranc Injuries Treated with a Suture Button Device

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding the optimal treatment of Lisfranc injuries of the midfoot. There has been increasing interest in using a suture button device in lieu of traditional screw fixation. Biomechanical studies comparing screw fixation with suture button devices have demonstrated conflicting results. This study evaluates the radiographic outcomes of patients with Lisfranc injuries treated with a suture button device or a hybrid technique with supplemental fixation. Methods: Forty-three patients with a Lisfranc injury were treated operatively with either a suture button device (Tightrope, Arthrex, Naples, FL) or a hybrid technique with supplemental hardware fixation. The distances between the first and second metatarsal (M1-M2) and the medial cuneiform and second metatarsal (C1-M2) were measured on weightbearing radiographs. These measurements were used to assess the accuracy of reduction, maintenance of reduction, and magnitude of reduction. The accuracy of reduction was determined by comparing weightbearing AP radiographs of the uninjured foot with weightbearing radiographs of the operatively treated foot at 6 weeks postoperatively. The magnitude of reduction was assessed via a comparison of weightbearing AP radiographs of the injured foot preoperatively to the operatively treated foot at 6 weeks postoperatively. The maintenance of reduction was determined by comparing radiographic measurements at 6 weeks postoperatively to measurements taken at 12 weeks postoperatively. Results: An accurate reduction was obtained in both treatment groups with no significant difference in the M1-M2 and C1-M2 measurements at 6 weeks postoperatively compared to the uninjured foot. The magnitude of reduction was greater and statistically significant for the hybrid fixation group but was not maintained (Hybrid fixation M1-M2 magnitude of reduction: -1.39, p < .001; C1-M2 magnitude of reduction: -1.77, p < .001). The suture button treatment group attained a satisfactory reduction that was maintained with no statistically significant difference in the M1-M2 and C1-M2 distances at 6 weeks and 12 weeks postoperatively (Tightrope M1-M2 maintenance of reduction: 0.04, p=0.88; C1-M2 maintenance of reduction: 0.39, p=0.21). Conclusion: After open reduction of Lisfranc injuries, the suture button device appears to adequately maintain the reduction when patients have returned to full activity. Based on radiographic parameters, the suture button construct provides an effective alternative to traditional screw fixation for the treatment of Lisfranc injuries.