Midfoot Injuries (Lisfranc Injuries): Lisfranc Ligament Repair With Adjustable Sutures

Midfoot Injuries (Lisfranc Injuries): Lisfranc Ligament Repair With Adjustable Sutures

This video will provide a cadaveric demonstration of the surgical treatment of a Lisfranc complex injury. An adjustable suture will be used to hold the injury and joint in place while it heals. In addition to the suture, 2 metal implant buttons will be used.

In review, the anatomy of the Lisfranc complex includes 4 bones: the medial cuneiform, the middle cuneiform, the first metatarsal base, and the second metatarsal base. The complex also includes several ligaments, including those pictured on the top of the foot. When a Lisfranc complex injury occurs, damage to these ligaments and widening is seen between the bones.

Here is the top of a left foot. The surgeon will begin by making an incision at the top of the foot, just outside the base of the second metatarsal. The metatarsal bone is seen at the base of the incision. Before introducing a drill, a surgical instrument called a mini Hohmann will be placed under the bone to protect the structures below it, and a retractor will be used to hold tissue out of the field of vision.

A temporary wire will be drilled through the metatarsal and medial cuneiform bone, exiting on the foot's inner side. This will serve as the path for the eventual suture placement. X-rays will be taken to confirm the location of the temporary wire. An incision will then be made over the exit point of the wire on the inner foot. A drill will be used over the wire.

The wire is removed. It is flipped around and slid back through the hole with the suture now attached to the back through a metal loop on the wire. The wire is pulled through the path in the bone with the attached suture and metal implant button. The button will pass along with the suture through the tunnel until it exits at the second metatarsal.

The surgeon will grab the button and gently pull the other end of the suture while visualizing it being placed securely against the bone. Another button on the end of the suture will be slid down until it meets the foot. The ends of the suture will be pulled taut while the button is guided down to bone. The suture ends will be wrapped around a hand-gripped instrument, which will slowly adjust and tension the button into place.

The button placement and the position of the complex, which has now been brought into normal alignment for healing, will be confirmed under x-ray. The suture ends will be trimmed, and the incisions will be closed. The surgery is now complete.