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DeGenova DT, Mennona S, Jones TJ, Hoffman A, Davis T, Cantor N, Taylor BC. Lisfranc Open Reduction and Internal Fixation. J Orthop Trauma 2024; 38:S14-S15. [PMID: 39007635 DOI: 10.1097/bot.0000000000002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 07/16/2024]
Abstract
VIDEO AVAILABLE AT https://ota.org/education/ota-online-resources/video-library-procedures-techniques/lisfranc-open-reduction-and.
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Affiliation(s)
- Daniel T DeGenova
- OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH; and
| | | | | | - Adam Hoffman
- Department of Orthopedics, OhioHealth, Columbus, OH
| | - Trent Davis
- Department of Orthopedics, OhioHealth, Columbus, OH
| | - Nikki Cantor
- Department of Orthopedics, OhioHealth, Columbus, OH
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Lachance AD, Giro ME, Edelstein A, Lee W. Suture button fixation yields high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries: A systematic review. J ISAKOS 2023; 8:474-483. [PMID: 37611870 DOI: 10.1016/j.jisako.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
IMPORTANCE Lisfranc injuries remain a significant, but often misdiagnosed, orthopaedic injury. Alongside the traditional methods of surgical fixation, including arthrodesis and open reduction and internal fixation with screws, suture button fixation is an emerging technique. OBJECTIVES The purpose of this study is to investigate the efficacy of suture button fixation for treatment of Lisfranc injuries through a systematic review. EVIDENCE REVIEW A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews using PubMed, Embase, Web of Science, and Cochrane databases for original, English-language studies observing outcomes of Lisfranc injury until August 19, 2022. The clinical studies with evidence level I-IV and at least a 12 month follow-up after the index surgery were included if they examined quantifiable outcomes of Lisfranc injury treated with suture button. Articles were excluded if they included case reports, systematic reviews, comments, editorials, surveys, animal studies, or biomechanical/cadaveric studies. Variables extracted from text and figures include demographic information, return to sport measures, patient reported outcomes, and complications. FINDINGS Of the 10 studies included, there were 186 total patients with an age range of 13-72. In every study, all patients were able to return to sport or activity with a return time averaging from 10.8 to 25.9 weeks. Postoperative American Orthopaedic Foot and Ankle Society scores ranged from 83.5 to 97.0 while pain Visual Analogue Scale ranged from 0.6 to 2.5. Complications were reported in four studies at a rate of 7.7% including two cases of diastasis, two cases of paraesthesia, one case of button irritation, and one of postoperative degenerative joint disease, with no reported revisions. CONCLUSIONS AND RELEVANCE In our systematic review, suture button fixation shows high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries. This surgical technique provides a physiologic reduction across the Lisfranc joint and reduces the need for reoperation including removal of hardware. However, further evidence such as large sample size high-quality randomized controlled trials is needed to draw a definitive conclusion regarding the best treatment for Lisfranc injuries. LEVEL OF EVIDENCE Level IV, Systematic Review of Level III and IV studies.
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Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Margaret Elizabeth Giro
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Alexander Edelstein
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
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Walsh A, Kasture S, Sugathan H, Dalal R. Long term results and patient reported outcome measures following lisfranc injuries treated with memory staple fixation. Foot (Edinb) 2023; 56:101991. [PMID: 36924628 DOI: 10.1016/j.foot.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Various modalities of fixation have been proposed for Lisfranc injuries. Memory staple fixation offers a simple option for transarticular fixation in suitable fracture configuration with no diaphyseal extension. However there is little evidence available in the literature regarding its efficacy and patient reported outcomes. Aim of the study was to present the long term outcomes of Lisfranc injuries treated with memory staple fixation and patient reported outcomes at average follow-up of four years. METHOD This was a retrospective analysis of all the patients who underwent fixation for Lisfranc injury using shape memory alloy (Nitinol) staples from December 2010 to October 2018. Patient demography, mechanism of injury, classification of Lisfranc injury, duration of followup, complication, revision surgery, implant removal and patient reported outcomes (AOFAS midfoot score) was noted. RESULTS 31 patients satisfied the inclusion criteria. Mean age was 50 years and 17 patients were females. 54 % patients reported low to moderate energy trauma which included simple fall from standing height or twisting injury. 28 (90.3 %) had B2 type of fracture pattern. 13 had fixation with staples only, 15 with a staple and home run screw. No patient had primary fusion. One patient had superficial infection treated with antibiotics only. Three patients developed symptomatic arthritis, out of which one proceeded to fusion. Six had implant removal for hardware related symptoms. Average AOFAS midfoot score at average four years follow-up was 77.8 which are satisfactory. CONCLUSION This paper highlights good outcome following memory staple fixation for Lisfranc injuries. We believe staples are more suited for the dorsal buttressing that is typically required and provide stable, reproducible fixation Our findings also suggest less need for implant removal compared to transarticular screw or plate fixation though larger studies would be required to make definitive conclusions.
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Affiliation(s)
- Anna Walsh
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
| | - Sarang Kasture
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK.
| | - Hari Sugathan
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
| | - Rakesh Dalal
- Stepping Hill Hospital, Stockport NHS Hospital Trust, Poplar grove, Stockport, UK
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Chona DV, Park CN, Kim BI, Lau BC. Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231186387. [PMID: 37538534 PMCID: PMC10395171 DOI: 10.1177/23259671231186387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 08/05/2023] Open
Abstract
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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Affiliation(s)
- Deepak V. Chona
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Billy I. Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Carter TH, Heinz N, Duckworth AD, White TO, Amin AK. Management of Lisfranc Injuries: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202304000-00001. [PMID: 37014938 DOI: 10.2106/jbjs.rvw.22.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
» 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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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas Heinz
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anish K Amin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Ma C, Jennings MM. Lisfranc Injuries in the Athlete. Clin Podiatr Med Surg 2023; 40:39-54. [PMID: 36368847 DOI: 10.1016/j.cpm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
LisFranc injuries in the active, athletic, and military populations can be devastating injuries. There has been much debate over open reduction and internal fixation versus arthrodesis as primary treatment in these injuries. This article aims to present the existing evidence-based medicine to help guide appropriate treatment in this population. With the introduction of flexible fixation, the variety of ways to address these injuries surgically has expanded.
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Affiliation(s)
- Christina Ma
- Staint Mary's Foot & Ankle Surgical Residency Program, 450 Stanyan Street, San Francisco, CA 94117, USA
| | - Meagan M Jennings
- Silicon Valley Foot & Ankle Reconstructive Fellowship, Palo Alto Foundation Medical Group / Sutter Health, 701 East EL Camino Real, Mountain View, CA 94040, USA.
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Sullivan M, Peckston D, Alpuerto B. Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review. Orthop J Sports Med 2022; 10:23259671221102969. [PMID: 35757241 PMCID: PMC9218474 DOI: 10.1177/23259671221102969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Isolated unstable Lisfranc ligament injuries in elite athletes are associated with a lengthy period of rehabilitation and prolonged absence from competition. Purpose: To assess the efficacy of a knotless, interosseous suture button system for repairing isolated unstable ligamentous Lisfranc injuries and its capacity to allow accelerated rehabilitation with earlier weightbearing and return-to-play times in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed data from a prospectively compiled database for elite athletes treated by a single surgeon. All included patients had clinical and magnetic resonance imaging evidence of an unstable isolated complete ligamentous Lisfranc injury requiring surgical reduction and stabilization. All patients underwent surgery using a knotless interosseous suture button to achieve stabilization, followed by a standardized postoperative regimen involving full weightbearing at 4 weeks, and all had a minimum postoperative follow-up of 2 years. Results: Included were 12 patients: 7 National Rugby League (NRL) players, 2 professional dancers, 1 Olympic gymnast, 1 professional wakeboarder, and 1 professional NRL referee. The mean age of the patients was 21.1 years (range, 16-34 years). Ten patients underwent acute surgical stabilization within 3 weeks of the injury, and 2 patients sustained chronic isolated Lisfranc instability that was initially treated nonoperatively. All athletes were able to return to full weightbearing by 4 weeks postoperatively, successfully returned to training by 9 to 12 weeks, and returned to full competition by 12 to 16 weeks. No major complications were reported. Conclusion: Knotless interosseous suture button stabilization was a reliable treatment option for both acute and chronic isolated ligamentous Lisfranc injuries in these elite athletes. This technique does not require hardware removal, allows early weightbearing with accelerated rehabilitation, and may shorten the return-to-play interval.
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Affiliation(s)
- Martin Sullivan
- St. Vincent’s Clinic, Sydney, Australia
- Martin Sullivan, FRACS, FAOrth, St. Vincent’s Clinic, 438 Victoria St, Darlinghurst, NSW 2010, Australia ()
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Fischer S, Klug A, Faul P, Hoffmann R, Manegold S, Gramlich Y. Superiority of upper ankle arthrodesis over total ankle replacement in the treatment of end-stage posttraumatic ankle arthrosis. Arch Orthop Trauma Surg 2022; 142:435-442. [PMID: 33389022 DOI: 10.1007/s00402-020-03714-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Surgical treatment of end-stage posttraumatic upper ankle arthrosis is challenging. Highly variable revision rates have been reported with total ankle arthroplasty (TAA) of the upper ankle joint. The aim of this retrospective study was to compare revision rates with tibiotalar arthrodesis (TTA) and TAA with a prosthesis to determine the superior treatment approach. METHODS Data for 148 patients (96 males and 52 females) with end-stage posttraumatic upper ankle arthrosis-including 88 treated with TTA and 60 with TAA between 2008 and 2013, with a mean follow-up of 59 months-were analysed. Bone fusion was confirmed by x-ray radiography and computed tomography. RESULTS The overall revision rate was 28%; the rate was higher with TAA (42%) than with TTA (18%). The TAA group showed an increase in revisions from 12- to 24-month postsurgery. The most common cause of revision in the TAA group was cysts (20%), and the most frequent reason for revision was nonunion (8%). Mean American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome (FAO) scores in all patients were 55.5 and 53.1, respectively, with no significant difference between the TTA and TAA groups (p > 0.05). In nine cases (15%) the prosthesis was explanted or converted to TTA. TAA patients who underwent conversion to TTA had worse outcomes (AOFAS score = 39; FAO score = 35.29). CONCLUSION TAA is associated with a high rate of revisions, especially from the 2nd year postsurgery. Therefore, TTA is the treatment of choice for end-stage posttraumatic upper ankle arthrosis. Level of evidence Level III, comparative series.
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Affiliation(s)
- Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Germany.
| | - Alexander Klug
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Philipp Faul
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Reinhard Hoffmann
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Sebastian Manegold
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Germany
| | - Yves Gramlich
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
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