SLR- November 2022- Andrew Ganshirt, DPM
Title: Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric ModelReference: Koroneos ZA, Manto KM, Martinazzi BJ, Stauch C, Bifano SM, Kunselman AR, Lewis GS, Aynardi M. Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model. Am J Sports Med. 2022 Oct;50(12):3299-3307. doi: 10.1177/03635465221118580. Epub 2022 Aug 22. PMID: 35993448; PMCID: PMC9527447.
Level of Evidence: Level III
Reviewed by: Andrew Ganshirt, DPM
Residency Program: Ascension SE Wisconsin
Podiatric Relevance: Treatment and fixation constructs regarding ligamentous Lisfranc injuries remains controversial. Several methods including transarticular screws, bridge plating, fusion and flexible fixation have all been described. Furthermore, non-flexible fixation often requires secondary surgery for implant removal, leading surgeons to seek other methods.
Methods: Eight matched pairs of fresh, previously frozen cadaveric specimens were prepped with a purely ligamentous lisfranc injury and fixated with either two cannulated transarticular crossed screws (CTC) or fiber tape construct with a supplemental intercuneiform limb. Diastasis was measured across the Lisfranc complex preinjury, post-injury and post-fixation at 50% donor body weight. Increasing cyclic loading at 1Hz and 100 cycles was then performed from 100 to 2000N, simulating partial weightbearing and high energy activity. Fixation failure was defined as >2mm at Lisfranc articulation.
Results: No significant differences in diastasis were detected at the Lisfranc articulation or the intercuneifrom joint throughout all loading cycles between groups. Mean diastasis at 50% BW +1400N at Lisfranc joint for the fiber tape was 0.90 +/- 0.50 and 0.68 +/- 1.06 for the screw group. Fibertape had significantly less intermediate cuneiform (IC) and second metatarsal diastasis than the screw group. Failure was noted to all specimens at 50% bodyweight +1400 N with 2 in the screw group noted prior to this and none in the fiber tape group.
Conclusions: Ligamentous Lisfranc injuries can lead to pain, instability, osteoarthritis, and morbidity, especially in the athletic population if left untreated. Previous biomechanical studies have shown no significant difference between screw and flexible fixation without supplemental intercuneiform stabilization. This study adds to that body of research with the addition of the intercuneiform stabilization which may provide less diastasis at the 2nd metatarsal-intermediate cuneiform joint. Fibertape may provide a viable alternative to screw fixation without the need for subsequent hardware removal.