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; < .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; = .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, = .1; intact vs suture button: 0.6 vs 1.8 mm, = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, = .5; intact vs suture button: 1.3 vs 2.1 mm, = .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.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10395171PMC
http://dx.doi.org/10.1177/23259671231186387DOI Listing

Publication Analysis

Top Keywords

suture button
24
ligamentous lisfranc
20
lisfranc injury
16
clinical biomechanical
12
button fixation
12
intact screw
12
fixation
9
fixation ligamentous
8
systematic review
8
treatment ligamentous
8

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!