Suture Button vs Conventional Screw Fixation for Isolated Lisfranc Ligament Injuries

Background: Suture buttons have been used for isolated Lisfranc ligament (ILL) fixation. However, no study has reported on its clinical and radiologic outcomes. Method: In this retrospective comparative study, patients with ILL injuries were divided into 2 groups according to the treatment method: 32 conventional screw group and 31 suture button group. The clinical and radiologic outcomes at preoperation, 6 months and 1 year postoperation, and last follow-up period were measured. Plantar foot pressure was measured at postoperative month 6 months. Postoperative complications at the last follow-up were evaluated. Result: The suture button group showed better American Orthopaedic Foot & Ankle Society midfoot scale ( P < .001) and visual analog scale ( P < .001) scores compared with the conventional screw fixation group at the postoperative month 6 period before screw removal. However, no significant difference in clinical outcome between the 2 groups was found at postoperative year 1 or last follow-up. No differences in radiologic outcomes were found between the 2 groups. Plantar foot pressure was significantly elevated in the conventional screw group at the great toe and first metatarsal head area compared with the contralateral foot just before screw removal. Recurrent Lisfranc joint diastasis was found in a single case in the conventional screw group and 2 cases in the suture button group. Conclusion: Suture button fixation in the treatment of ILL injuries may provide comparable fixation stability and clinical outcome with conventional screw fixation in the early postoperative period. Level of Evidence: Level III, retrospective case-control study, therapeutic.

Morphological characteristics of the Lisfranc ligament

Background This study aimed to clarify the morphological characteristics of the Lisfranc ligament and the plantar ligament. Methods Forty legs from 20 cadavers were examined. Classification proceeded according to the number of fiber bundles in the Lisfranc ligament and the plantar ligament. Morphological features measured were fiber bundle length, width, thickness, and angle. Results In Type I-a, the Lisfranc and plantar ligaments were a single fiber bundle; in Type I-b, the Lisfranc ligament was a single fiber bundle, and the plantar ligament was two fiber bundles; in Type II-a, the Lisfranc ligament was a two fiber bundle, and the plantar ligament was a single fiber bundle; in Type II-b, the Lisfranc ligament and the plantar ligament were two fiber bundles; in Type III-a, the Lisfranc ligament was three fiber bundles, and the plantar ligament was a single fiber bundle; in Type III-b, the Lisfranc ligament was three fiber bundles, and the plantar ligament was two fiber bundles; in Type IV, the Lisfranc ligament and the plantar ligament could not be separated. Type I-a was seen in 37.5%, Type I-b in 10%, Type II-a in 30%, Type II-b in 7.5%, Type III-a in 7.5%, Type III-b in 2.5%, and Type IV in 5%. The Lisfranc ligament was significantly larger than the plantar ligament in total fiber bundle width, total fiber bundle thickness, and total fiber bundle angle. Conclusion The Lisfranc ligament had three fiber bundles, and the plantar ligament had two fiber bundles; classifications were four types and two subgroups.

Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics

Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region.

Anatomy of the Lateral Plantar Ligaments of the Transverse Metatarsal Arch

Background: While the anatomy of the Lisfranc complex is well understood, the lateral tarsometatarsal ligamentous structures, in contrast, are less well studied. Our aim in this study was to identify an anatomical explanation as to why the second to fifth metatarsals function as a unit in homolateral and divergent midfoot injuries. Methods: Eleven cadaveric lower limbs, preserved in formaldehyde, were examined at the University of Liverpool Human Anatomy and Resource Centre. Each of the lower limbs was dissected to identify the plantar aspect of the transverse metatarsal arch. Results: On removal of the long plantar ligament, the peroneal longus tendon was visible, as was its insertion onto the first metatarsal base. A lateral Lisfranc ligament (which was a transverse suspensory metatarsal ligament) spanned between the bases of the second and fifth metatarsals in all specimens with an average length of 33.7 mm and width of 4.6 mm. This ligament has not previously been described. It was noted that in all specimens, the long plantar ligament blended with the lateral Lisfranc ligament. In addition to the lateral Lisfranc ligament, separate intermetatarsal ligaments were identifiable connecting each metatarsal. The long plantar ligament provided a connection through the lateral Lisfranc ligament connecting the transverse and longitudinal arches of the foot. Conclusion: We found a plantar ligament that provided connection through the long plantar ligament of both the transverse and the longitudinal arches. It spanned from the second to the fifth metatarsal, which we believe may explain that in some cases, lateral instability can be overcome when the middle column is stabilized. Clinical Relevance: We suspect that in the majority of homolateral and divergent types of tarsometatarsal injuries that the lateral Lisfranc ligament remains intact and thus it has significant clinical ramifications.