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Lisfranc Injuries in Athletes: Surgical Treatment Techniques

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Ligamentous Injuries of the Foot and Ankle

Abstract

The Lisfranc joints are the primary midfoot articulations that involve the tarsal and metatarsals.

Stability of the midfoot is dependent on obtaining and maintaining alignment of these joints.

The second metatarsal base is the keystone to the transverse and longitudinal arch of the foot.

The tarsal-metatarsal and intercuneiform ligaments (Lisfranc ligaments) must be intact to provide long-term mechanical stability.

The medial cuneiform-second metatarsal ligament provides stability to the keystone of the midfoot arch and is often termed “the Lisfranc ligament.”

Sports is a low-velocity mechanism for Lisfranc injury and often involves a purely ligamentous injury.

Proximal extension of the ligament disruption involves the medial and middle intercuneiform ligament up to 50% of the time in sports injuries.

Non-operative treatment of unstable Lisfranc injuries has a very limited role in the athlete.

Stabilization of all disrupted ligaments is required to allow the athlete to return to sport.

Open, anatomic reduction with rigid fixation for 3–5 months is the mainstay of treatment to allow ligament healing and long-term stability.

Bridge plating for the first TMT joint has recently become more popular.

Percutaneous rigid fixation and arthrodesis have been described but are not as common in the competitive athlete.

Isolated suture button fixation is experimental in the athlete.

Absorbable plate and screw fixation are not recommended in the athlete at this time.

Non-weight-bearing is required for 6–8 weeks after each operative stabilization.

Removal of hardware is often undertaken after ORIF and prior to return to sports.

Return to play often requires 6–12 months of rehabilitation.

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Correspondence to David A. Porter .

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Electronic Supplementary Material

Open reduction and internal fixation (ORIF) Lisfranc repair [10]. Demonstration of an ORIF repair of the Lisfranc. The video reviews positioning, approach, screw placement, and imaging. (MP4 482639 kb)

Percutaneous Lisfranc fixation. Video of Lisfranc fixation using percutaneous treatment. Procedures demonstrated include fluoroscopic imaging, reduction, positioning, K-wire stabilization, and screw placement. (MP4 163468 kb)

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Porter, D.A., Schmidt, G.J. (2022). Lisfranc Injuries in Athletes: Surgical Treatment Techniques. In: D’Hooghe, P., Hunt, K.J., McCormick, J.J. (eds) Ligamentous Injuries of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-08682-3_20

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  • DOI: https://doi.org/10.1007/978-3-031-08682-3_20

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