Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais (MG), Brazil.
Foot Ankle Int. 2020 Jun;41(6):735-743. doi: 10.1177/1071100720907878. Epub 2020 Mar 1.
Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct.
Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with < .05 considered significant.
Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape ( < .001).
We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability.
This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.
Lisfranc 损伤代表了从中高能量损伤导致的严重不稳定的中足，到低能量损伤导致的轻微半脱位或不稳定但无明显移位的损伤谱。最近，人们正在评估允许这种多平面关节生理固定的治疗选择。本研究的目的是分析新型缝线增强型新韧带成形术与传统经关节螺钉固定结构固定的 Lisfranc 损伤模型的稳定性。
本研究使用了 24 个新鲜冷冻、匹配的下肢和足部标本（12 名年龄小于 65 岁的个体）。测试了两种不同类型的 Lisfranc 韧带损伤：部分损伤和完全损伤。比较了两种不同的固定方法：经关节螺钉和带 FiberTape 的增强缝线韧带成形术。标本固定在旋转平台上，以便在施加 400 N 的轴向载荷和内、外旋转时对关节施加应力。使用三维数字化仪臂测量并比较了 6 个距离，以评估它们之间的稳定性。使用方差分析， <.05 被认为具有统计学意义。
使用分布图表和分析分组数据，观察到两种稳定方法之间没有差异，但增强缝线韧带成形术的变异性较低，观察到的距离缩短更可能接近平均值。螺钉固定的变异性是带固定的 2.9 倍（ <.001）。
我们建议增强缝线韧带成形术可以达到与经典经关节螺钉相似的稳定性，且变异性更小。
这项尸体研究为 Lisfranc 损伤治疗的争论增添了新的信息。像使用的合成韧带成形术这样的灵活固定可以恢复良好的稳定性，就像传统的经关节螺钉一样。
