Patient Reported Outcomes Following Lisfranc Stabilisation using the Internalbrace System

Research Type: Level 4 – Case series Introduction/Purpose: Lisfranc injuries are a challenging presentation frequently encountered by foot and ankle and trauma surgeons, with no definitive consensus on the optimal fixation technique. Lisfranc injuries can frequently lead to posttraumatic arthritis without timely diagnosis and appropriate management. Primarily ligamentous Lisfranc injuries, which result from lower energy sporting injuries, have been reported to have a poorer prognosis in the literature. The purpose of this study was to confirm the safety and efficacy of Lisfranc stabilisation utilising a FiberTape device (Arthrex Internalbrace) in a cohort of patients with acute primarily ligamentous Lisfranc injuries, utilising patient reported outcome measures. Methods: Analysis was performed on 20 patients who underwent open reduction and internal fixation (ORIF) of their Lisfranc injuries with bridge plating of the tarsometatarsal joints (TMTJ) and stabilisation of the Lisfranc interval with an Internalbrace construct spanning the interval between the medial cuneiform (C1) and base of the 2nd metatarsal (M2). Pre and postoperative visual analogue scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores, and postoperative complications were evaluated. A bespoke 15 item sports questionnaire evaluating the frequency and intensity of sporting activities was also completed by patients. Results: 9 males and 11 females were included in this study. The mean follow-up duration was 31.8 months (range 12 – 61 months). 19 patients exercised regularly or played sports across various levels including recreationally, or for a club. The minimum follow-up duration was 1 year. The mean AOFAS and VAS scores improved significantly from 32.1 ± 19.9 and 6.2 ± 2.2 preoperatively to 90.6 ± 9.4 and 1.6 ± 0.8 postoperatively, respectively. Age, gender, and time to surgery did not significantly affect the outcomes. There were no unplanned return to theatres. One minor wound complication was noted. Conclusion: Lisfranc stabilisation using the Internalbrace appears to be a safe and effective technique and is associated with significant improvement in patient reported function, and reduction in pain, after a Lisfranc injury at intermediate term follow-up. The major purported benefit of the suture button technique vs the use of a screw across the Lisfranc interval is the minimisation of articular injury and violation of the Lisfranc joint, thereby reducing risk of iatrogenic arthrosis.