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Foot Ankle Int. 2011 Apr;32(4):422-31. doi: 10.3113/FAI.2011.0422.

A biomechanical analysis of a tensioned suture device in the fixation of the ligamentous Lisfranc injury.

Author information

1
University Orthopaedic Center, Salt Lake City, UT 84108, USA.

Abstract

BACKGROUND:

We hypothesized that using a cadaveric Lisfranc ligamentous injury model, abduction stress would provoke greater post-injury motion than axial weightbearing between the medial cuneiform (MC1) and the base of the second metatarsal (MT2). Second, we hypothesized that both a tensioned suture-button device and a rigid screw fixation method could maintain a reduction and similarly restrain motion to intact (pre-injury) levels.

MATERIALS AND METHODS:

Motion was measured between MC1 and MT2 in five matched pairs of human cadaveric feet. Specimens were tested prior to injury, following a transverse ligamentous Lisfranc injury, and then randomized to either screw or tensioned suture-button fixation. Axial then abduction loads were applied. Measurements were repeated after one thousand loading cycles.

RESULTS:

With both axial and abduction loads, statistically significant differences in motion were detected between the intact and post-injury conditions, although the magnitudes were greater with abduction (6.8 mm versus 2.0 mm, p = 0.000004). With abduction loads, both fixation methods were effective in restraining motion to pre-injury levels (screw fixation: 1.5 mm intact versus 1.1 mm post-fixation, p = 0.487; suture-button fixation: 1.3 mm intact versus 2.1 mm post-fixation, p = 0.063), and similarly, both devices restrained motion to less than post-injury levels (screw fixation: 8.1 mm post-injury versus 1.1 mm post-fixation, p = 0.001; suture-button fixation: mean 5.5 mm post-injury versus 2.1 mm post-fixation, p = 0.0002). No significant differences in these patterns were detected following cyclic loading.

CONCLUSION:

Small, though statistically significant, amounts of motion are produced between MC1 and MT2 with axial loading after a ligamentous Lisfranc injury. With abduction stress, we were able to show a significantly greater difference between pre- and post-injury motion and the ability of both fixation methods to restrain motion to pre-injury levels.

CLINICAL RELEVANCE:

Abduction stress may be valuable when diagnosing and testing the transverse ligamentous Lisfranc injury. Both suture-button and screw fixation methods restrain motion at the Lisfranc complex.

PMID:
21733447
DOI:
10.3113/FAI.2011.0422
[Indexed for MEDLINE]

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