Comparison Between Operative Methods in Treatment of Isolate Lisfranc Injury - Various Flexible Fixation of Subtle Lisfranc Ligament Injury

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Category: Midfoot/Forefoot; Sports Introduction/Purpose: Recently, various suture button technique were introduced for isolated Lisfranc ligament(ILL) fixation. However, a few clinical and radiologic study focused on suture button fixation on the ILL injury has been reported. This study is comparative between conventional screw fixation versus various types of suture button(TightRopeTM, Internalbrace®) for the ILL ligament injury. Methods: This is a multicenter, retrospective study included patients were divided into two groups according to the treatment method: 35 conventional screw group, 34 TightRopeTM group and 30 internal brace fixation group. In terms of the clinical outcome, VAS score and AOFAS midfoot scale were used, evaluated at preoperative, postoperative 6 months, and last follow up period. In order to evaluate the radiologic outcome, weight bearing foot AP radiograph and weight bearing CT were taken to compare diastasis and side to side difference. Plantar foot pressure was measured in all the patients included after postoperative 6 months in three groups. Postoperative complications detected until the last follow up were analyzed between the three groups. Results: Two suture button groups showed better clinical outcome to conventional screw fixation group at postoperative 6 month follow up period. However, no significant difference between all groups was found at postoperative 1 year, and last follow up period. And no difference between three groups was found with regards to diastasis and side to side difference measured at weight bearing AP radiograph. Dorsal and plantar diastasis measured on WBCT were not significant different between three groups as well. Foot pressure was significantly elevated on conventional screw fixation group at forefoot then the other groups. Recurrent Lisfranc joint diastasis was found in a single case in conventional screw group and two cases in TightRopeTM group. but Internalbrace group was not found recurrent diastasis. Conclusion: Our investigation suggests that utilizing suture button fixation in the treatment of ILL injuries may offer reliable fixation stability with a few complications compare with standard screw fixation. And it may bring out better patient satisfaction in ILL in early postoperative follow up period.