Midfoot Injuries (Lisfranc Injuries): Lisfranc Ligament Repair With Tape Augmentation

Midfoot Injuries (Lisfranc Injuries): Lisfranc Ligament Repair With Tape Augmentation

This video will provide a cadaveric demonstration of the surgical treatment of a Lisfranc complex injury. A suture will be used to provide additional support and stabilize the injury while it heals in place. In addition to the suture, 2 bone anchors and a metal button implant will secure it to the bone.

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, a right foot is shown with an incision overlying the Lisfranc complex on the top of the foot. An x-ray of the bones underlying the incision is shown. The surgeon is identifying the outside edge of the base of the second metatarsal, both on x-ray and at the site of surgery. This location will serve as the starting point for the eventual path of the suture placement.

Soft-tissue retractors will hold the tissues away from the bony landmarks while the surgeon operates. A bone reduction clamp will be used to move the widened Lisfranc complex back to its normal alignment. The trajectory of this clamp will parallel the eventual trajectory of the suture placement. A temporary wire will be run along this path. The clamp has been removed in this demonstration, so the surgery can be easily seen. However, normally it is left in place to hold the complex in alignment.

A small incision will then be made on the inner aspect of the foot over the wire's exit point. A drill sleeve and drill bit will be placed over the wire to drill a hole down to bone. The wire will then be pulled from the inner foot until a small portion remains at the original entry point near the second metatarsal. The end of this wire has a small ring. Both ends of a looped suture will be fed through the wire ring.

A small metal button is seen on the end of the looped suture. The wire, with the attached suture and button, will be fed through the path in the bone, exiting on the foot's inner side. After the suture is pulled through the path, the metal button on the suture now sits flush against the second metatarsal. Then, where the hole was previously drilled on the inside of the foot, a bone anchor will be screwed into the medial cuneiform bone, all while capturing the suture.

An instrument will be used to clear a path between the 2 incisions. The path sits above the bone and under the soft tissue. The clamp at the tip of the instrument will grab the existing suture ends. Note that the ends of the suture have a smaller diameter than the broader, flat portion that will sit over the complex. As the suture ends are pulled through the path, the broad, flat portion of the suture will overlie the complex to provide additional support while it heals.

A drill will then be used to make a small hole on the top of the middle cuneiform bone for another bone anchor. The suture will be threaded into the eyelet on a bone anchor, and together, they will be inserted into the bone. The suture ends will then be cut. The incisions will be closed, and the surgery is now complete.