Dayton Steven R, Krautmann Kurt M, Boctor Michael J, Tjong Vehniah K, Kadakia Anish R
Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Northwestern Medicine, Chicago, Illinois, USA.
Video J Sports Med. 2021 Dec 2;1(6):26350254211042885. doi: 10.1177/26350254211042885. eCollection 2021 Nov-Dec.
Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals.
We present a novel technique for repair of homolateral Lisfranc fracture/dislocation of metatarsals 1-5 which may be used in high-level athletes attempting to return to competition.
A dual approach is utilized, with a dorsal approach to allow for fusion of the 2nd and 3rd TMT joints and medial approach for internal bracing of the 1st TMT joint. The 2nd and 3rd metatarsals were denuded of all cartilage and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites and then stability of the 1st TMT was reassessed. A guidewire for the cannulated InternalBrace (Arthrex; Naples, FL) system is initially inserted into the base of the 1st metatarsal. Positioning is confirmed with fluoroscopic imaging and the 3.4 mm drill is passed over the wire, followed by the cannulated tap. A 4.75 mm SwiveLock anchor (Arthrex; Naples, FL) with FiberTape suture (Arthrex; Naples, FL) is then inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm SwiveLock anchor is then loaded with the FiberTape suture from the 1st metatarsal. Tensioning is performed, and the 3.5 mm SwiveLock anchor is inserted into the medial cuneiform.
The athlete was cleared to return to full competition 9 months following surgery. Physical examination demonstrated stability in dorsiflexion and abduction. Both weight-bearing x-rays and computed tomography scans showed no evidence of hardware failure, no instability of the 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints.
DISCUSSION/CONCLUSION: Current literature demonstrates that RTS is possible for athletes suffering from low-energy Lisfranc injuries. This novel surgical technique is the first to demonstrate return to sport of a high-level athlete from homolateral fracture/dislocation of all 5 metatarsals.
Lisfranc损伤包括从韧带扭伤到伴有脱位的骨折等一系列跗跖关节（TMT）复合体损伤。虽然研究表明低能量损伤后有可能重返运动（RTS），但尚无文献证明第1至5跖骨同侧骨折/脱位后能重返运动。
我们提出一种修复第1至5跖骨同侧Lisfranc骨折/脱位的新技术，可用于试图重返比赛的高水平运动员。
采用双入路方法，背侧入路用于第2和第3跗跖关节融合，内侧入路用于第1跗跖关节的内支撑。去除第2和第3跖骨的所有软骨并充分准备融合部位。对融合部位进行坚固固定，然后重新评估第1跗跖关节的稳定性。首先将空心InternalBrace（Arthrex公司；佛罗里达州那不勒斯）系统的导丝插入第1跖骨基部。通过透视成像确认位置，然后将3.4毫米钻头沿导丝穿过，接着使用空心丝锥。然后将带有FiberTape缝线（Arthrex公司；佛罗里达州那不勒斯）的4.75毫米SwiveLock锚钉插入跖骨基部。将导丝置于内侧楔骨上的往复位置。将2.7毫米钻头沿导丝穿过，接着使用3.5毫米丝锥。然后将带有来自第1跖骨的FiberTape缝线的3.5毫米SwiveLock锚钉装入。进行张力调节，然后将3.5毫米SwiveLock锚钉插入内侧楔骨。
该运动员术后9个月被批准完全恢复比赛。体格检查显示背屈和外展时稳定。负重X线片和计算机断层扫描均未显示硬件故障、第1跗跖关节不稳定以及第2和第3跗跖关节牢固融合的迹象。
讨论/结论：现有文献表明，低能量Lisfranc损伤的运动员有可能重返运动。这种新颖的手术技术首次证明了一名高水平运动员从第1至5跖骨同侧骨折/脱位后重返运动。
