Simulated Weightbearing and Articular Injury From Transarticular Screws in a Ligamentous Lisfranc Injury Model.

Background: Transarticular screw fixation is a common surgical treatment for tarsometatarsal ligamentous (Lisfranc) injuries. Iatrogenic damage to articular cartilage from screw placement, however, has been thought to potentially lead to increased risk of tarsometatarsal (TMT) joint arthritis after initial injury. To date, no study has evaluated the effect of weightbearing on articular cartilage after screw fixation. The aim of this study was to create a Lisfranc injury and quantify and compare articular damage due to screw fixation before and after simulated weightbearing.

Methods: A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed.

Results: Simulated partial weightbearing increased articular injury 1.44-fold ( < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold,  = .0047), whereas the first (M1) showed the least (1.35-fold,  = .0083). Increases seen at the medial (1.43-fold,  = .0387) and middle cuneiform (1.44-fold,  = .0292) were intermediate between the values seen at M2 and M1.

Conclusion: Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries.

Clinical Relevance: Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.