Patient-Reported Outcomes Following Lisfranc Fixation via Articular Bridge Plating Combined With the Suture Tape Ligament Reconstruction Technique.

Abstract

Background: Lisfranc injuries are challenging presentations frequently encountered by foot and ankle and trauma surgeons, with no definitive consensus regarding the optimal fixation technique. This study aimed to evaluate the safety and efficacy of a modified stabilisation technique combining tarsometatarsal joint (TMTJ) bridge plating with a suture tape-endobutton construct for Lisfranc joint stabilisation, using patient-reported outcomes in a cohort of patients with acute injuries.

Methods: A retrospective review was performed on 20 consecutive patients with acute Lisfranc injuries treated with open reduction and internal fixation (ORIF). Fixation involved TMTJ bridge plating and stabilisation of the Lisfranc interval using a suture tape-endobutton construct spanning the medial cuneiform (C1) and the base of the second metatarsal (M2). All patients underwent planned removal of bridge plates with retainment of the suture tape construct. Pre- and postoperative visual analogue scale (VAS) scores and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were collected, along with postoperative complication and reoperation rates.

Results: The cohort comprised 9 males (45%) and 11 females (55%). Time to surgery ranged from 1.5 to 12 weeks. Mean follow-up was 31.8 months (range 12-61 months). At final follow-up, 18 of 19 patients (95%) who exercised preoperatively reported return to regular exercise or sporting activity. Mean AOFAS scores improved from 32.1 ± 19.9 preoperatively to 90.6 ± 9.4 postoperatively, and VAS scores improved from 6.2 ± 2.2 to 1.6 ± 0.8. There were no cases of unplanned reoperation, recurrent radiographic diastasis, or conversion to arthrodesis.

Conclusion: Our study of combined TMTJ bridge plating and suture tape ligament augmentation provides preliminary evidence of safety and efficacy for acute Lisfranc injuries in a small retrospective series. It appears to be a safe and effective technique for acute Lisfranc injuries, demonstrating favorable patient-reported outcomes and maintenance of reduction at intermediate follow-up. The suture tape construct minimises transarticular instrumentation and may reduce iatrogenic articular injury, potentially lowering the risk of midfoot stiffness, pain, and posttraumatic arthrosis.

Level of evidence: Level IV, case series.