SLR - March 2022 - Ying Shao
Reference: Yongfei F, Chaoyu L, Wenqiang X, Xiulin M, Jian X, Wei W. Clinical Outcomes of Tightrope Sys-tem in the Treatment Of Purely Ligamentous Lisfranc Injuries. BMC Surg. 2021. Nov 7;21(1):395.Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Ying Shao, DPM
Residency Program: Our Lady of Lourdes – Binghamton, NY
Podiatric Relevance: Purely ligamentous Lisfranc injuries are often a result of low energy tarsometatarsal trauma. There are myriads of surgical treatment options for ligamentous Lisfranc injuries, however, most involve a form of rigid fixation. Complications of rigid fixation may involve hardware failure and iatrogenic articular damage. The goal of this paper is to evaluate the efficacy in reducing displacement using a flexible construct known as the Tightrope system for reconstruction of Lisfranc ligament injury.
Methods: This study is a retrospective case series consisting of 11 patients with purely ligamentous Lisfranc injuries. Radiographs were obtained to assess the distance between the first and the second metatarsal pre-operatively, three months, six months postoperative and at the last follow up visit. Functional outcomes were evaluated at the last follow up visit using the American Orthopaedic Foot and Ankle Score (AOFAS) and the Maryland score. The operative procedure consisted of the Tightrope system with a button placed on the lateral surface of the second metatarsal base and fiber wire traversing through a bony tunnel for placement of the second button on the medial surface of the medial cuneiform.
Results: The mean follow up was 20.5 months. All incisions healed uneventfully, and no hardware associated complications were noted. Postoperative radiographs showed statistically significant improvement of the first and second metatarsal joint space compared to the preoperative finding (1.9 vs 8.9 millimeters). Similarly, there was a significant decrease in the VAS score from 7.1 preoperatively to 1.8 postoperatively. At the last follow up visit, patients appeared to have well-recovered foot function as the average AOFAS score was 92.4 and Mary-land score was 94.1.
Conclusions: In contrast to traditional rigid internal fixation, the Tightrope system appears to be a viable alternative in reducing deformity as a result of purely ligamentous Lisfranc injuries in this small cohort size. It offers stabilization of the tarsometatarsal joint, satisfactory functional outcomes, and may offer a reduced rate of complications compared to rigid fixation. Limitations of this study includes a small sample size and short follow up time.