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Koroneos ZA, Manto KM, Martinazzi BJ, Stauch C, Bifano SM, Kunselman AR, Lewis GS, Aynardi M. Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model. Am J Sports Med 2022; 50:3299-3307. [PMID: 35993448 PMCID: PMC9527447 DOI: 10.1177/03635465221118580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. PURPOSE To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. STUDY DESIGN Controlled laboratory study. METHODS Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal-medial cuneiform joint). RESULTS There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. CONCLUSION The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. CLINICAL RELEVANCE Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.
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Affiliation(s)
- Zachary A. Koroneos
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kristen M. Manto
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Brandon J. Martinazzi
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Chris Stauch
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shawn M. Bifano
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Allen R. Kunselman
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Gregory S. Lewis
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michael Aynardi
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA,Michael Aynardi, MD, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Dr, H089 Hershey, PA 17033, USA ()
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Koroneos Z, Vannatta E, Kim M, Cowman T, Fritsche M, Kunselman AR, Lewis GS, Aynardi M. Biomechanical Comparison of Fibertape Device Repair Techniques of Ligamentous Lisfranc Injury in a Cadaveric Model. Injury 2021; 52:692-698. [PMID: 33745699 DOI: 10.1016/j.injury.2021.02.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lisfranc ligamentous injuries are complex, and their treatment, along with the preferred method of fixation, is controversial. Implementing a flexible synthetic augmentation device (fibertape) has been described as an alternative to traditional screw fixation. This biomechanical study evaluated two fibertape devices with interference screw fixation: InternalBrace, and InternalBrace with supplementary intercuneiform stabilization. METHODS The diastasis and relative angular displacement between bones were measured at three midfoot joints in the Lisfranc articulation. Measurements were obtained for the pre-injured, injured, and post-fixation stages under static loading. Specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at 100 N ground reaction force intervals from 500 to 1200 N to simulate postoperative loading, and then up to 1800 N to simulate high loads. Failure of fixation was defined as diastasis greater than 2 millimeters at the second-metatarsal - medial-cuneiform joint. RESULTS InternalBrace specimens demonstrated failures in 3 of 9 (33%) specimens at cyclic loads of 1000 N. Conversely, InternalBrace with Supplementary Limb specimens had 1 failure at 1200 N. The difference in diastasis at the second metatarsal-medial cuneiform joint was statistically significant between the two groups at higher loads of 1600N (p = 0.019) and 1800N (p = 0.029). CONCLUSION The use of InternalBrace for ligamentous Lisfranc injuries appears to provide a biomechanically viable alternative for withstanding early postoperative protected weight bearing. Furthermore, the use of a supplementary limb in addition to the InternalBrace fibertape fixation method appears to enhance its biomechanical efficacy.
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Affiliation(s)
- Zachary Koroneos
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Emily Vannatta
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Morgan Kim
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Trevin Cowman
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Madelaine Fritsche
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Allen R Kunselman
- The Pennsylvania State University, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, 500 University Drive, H089 Hershey, PA, 17033.
| | - Gregory S Lewis
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Michael Aynardi
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
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Aynardi MC, Saloky K, Roush EP, Juliano P, Lewis GS. Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model. Foot Ankle Int 2019; 40:596-602. [PMID: 30822130 DOI: 10.1177/1071100719828373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The structural importance of the spring ligament complex in arch stability has been described. Furthermore, the pathology of this complex is often noted in patients with posterior tibial tendon dysfunction. The purpose of this biomechanical study was to evaluate spring ligament repair alone versus augmentation with the FiberTape device in a cadaveric flatfoot model. METHODS Eight paired, below-the-knee, cadaveric specimens underwent flatfoot creation and reconstruction. The experimental group received augmentation with FiberTape (InternalBrace). After potting, specimens were loaded statically to measure talonavicular contact pressures and flatfoot correction. Cyclic loading was performed in a stepwise fashion. Loading was performed at 1 Hz and 100 cycles, at 100-N intervals from 500 to 1800 N, with the Achilles tendon also loaded to simulate weightbearing in the postoperative period. RESULTS Control specimen analysis demonstrated failures of 8 of 8 (100%) spring ligament suture repairs, occurring through suture cut-through (5 specimens), suture fatigue and elongation (2), or knot failure (1). One of 8 (12.5%) FiberTape-augmented repairs failed after cyclic loading. The difference in number of repair failures was statistically significant between the 2 groups ( P = .0014). Analysis revealed that at forces of 1600 N ( P = .03) and 1700 N ( P = .02) there were statistically significant differences between the FiberTape-augmented group and the control group, with a greater collapse in the lateral Meary talo-first metatarsal angle in the controls. There was no significant difference or abnormal increase in contact pressures of the talonavicular joint in both groups. CONCLUSION FiberTape augmentation of the spring ligament appears biomechanically safe and effective under cyclic loading. CLINICAL RELEVANCE Spring ligament augmentation with this device may be another biomechanically safe and reasonable treatment modality for surgeons during flatfoot reconstruction. It is possible that early protected weightbearing after these procedures may be performed.
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Affiliation(s)
- Michael C Aynardi
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kaitlin Saloky
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Evan P Roush
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paul Juliano
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory S Lewis
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Abstract
Metatarsalgia is among the most common sources of forefoot pain. Proximal metatarsal osteotomies are an important technique in the armamentarium of the surgeon treating metatarsalgia that has failed nonoperative management. Proximal osteotomies can provide powerful deformity correction with precise control to both shorten and elevate the metatarsal head. However, they can be technically challenging, difficult to attain satisfactory fixation, require increased postoperative immobilization, and can result in transfer lesions. There are numerous described techniques with little supporting evidence and more research is needed to establish the optimal procedure to reliably alleviate patient's symptoms while minimizing complications.
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Affiliation(s)
- Emily C Vafek
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
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Aydogan U, Roush EP, Moore BE, Andrews SH, Lewis GS. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures. J Orthop Res 2017; 35:800-804. [PMID: 27279527 PMCID: PMC6002764 DOI: 10.1002/jor.23331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/07/2016] [Indexed: 02/04/2023]
Abstract
Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p < 0.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017.
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Affiliation(s)
- Umur Aydogan
- Department of Orthopaedics and Rehabilitation; Penn State Hershey Bone and Joint Institute; Penn State Milton S. Hershey College of Medicine; Hershey Pennsylvania
| | - Evan P. Roush
- Department of Orthopaedics and Rehabilitation; Penn State Hershey Bone and Joint Institute; Penn State Milton S. Hershey College of Medicine; Hershey Pennsylvania
| | - Blake E. Moore
- Department of Orthopaedics and Rehabilitation; Penn State Hershey Bone and Joint Institute; Penn State Milton S. Hershey College of Medicine; Hershey Pennsylvania
| | - Seth H. Andrews
- Department of Orthopaedics and Rehabilitation; Penn State Hershey Bone and Joint Institute; Penn State Milton S. Hershey College of Medicine; Hershey Pennsylvania
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation; Penn State Hershey Bone and Joint Institute; Penn State Milton S. Hershey College of Medicine; Hershey Pennsylvania
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Patrick N, Lewis GS, Roush EP, Kunselman AR, Cain JD. Effects of Medial Displacement Calcaneal Osteotomy and Calcaneal Z Osteotomy on Subtalar Joint Pressures: A Cadaveric Flatfoot Model. J Foot Ankle Surg 2016; 55:1175-1179. [PMID: 27545512 DOI: 10.1053/j.jfas.2016.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Indexed: 02/03/2023]
Abstract
Medial displacement calcaneal osteotomies have been shown to be successful in the surgical management of adult acquired flatfoot, in particular, stage 2 deformity. Classically, the medial displacement calcaneal osteotomy technique has been performed. However, a calcaneal Z osteotomy has been more recently described and applied in the surgical management of flatfoot deformity. Although the potential advantages of the calcaneal Z technique have been reported, data on its effect on the subtalar joint are lacking. A validated flatfoot model was induced in 8 cadaveric feet that had been randomly assigned to either medial displacement calcaneal osteotomy (n = 4) or calcaneal Z osteotomy (n = 4). The feet were loaded through the tibia with a constant ground reaction force of 400 N, with a simultaneous increase in the Achilles tendon force to 300 or 500 N. The subtalar joint pressures were recorded before and after osteotomy. We did not detect any statistically significant differences between the 2 techniques in terms of their effects on subtalar joint pressure.
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Affiliation(s)
- Nathan Patrick
- PGY-5 Orthopaedic Resident, Department of Orthopaedics and Rehabilitation, Penn State Hershey Medical Center, Hershey, PA
| | - Gregory S Lewis
- Assistant Professor, Department of Orthopaedics, Penn State College of Medicine
| | - Evan P Roush
- Research Engineering Specialist, Division of Musculoskeletal Science, Penn State College of Medicine, Hershey, PA
| | - Allen R Kunselman
- Senior Instructor, Department of Public Health Science, Penn State College of Medicine, Hershey, PA
| | - Jarrett D Cain
- Assistant Professor, Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Hershey Medical Center, Hershey, PA.
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