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Mechanical Behavior of the Lisfranc and Dorsal Cuneometatarsal Ligaments: In Vitro Biomechanical Study

Objectives To define the anatomy and mechanical properties of two ligaments stabilizing the medial tarsometatarsal joints: the Lisfranc ligament and the dorsal cuneometatarsal ligament. Design Cadaveric study in normal feet. Setting Biomechanics laboratory. Patients or Participants Twelve fresh-frozen cadaveric feet were studied. Intervention The Lisfranc and dorsal cuneometatarsal ligaments were dissected, dimensions measured, and material properties determined with a servohydraulic MTS machine on bone–ligament–bone preparations. Main Outcome Measurements Stiffness, strain, stress, modulus, failure load, ligament length, width, thickness, and cross-sectional area were determined. Results Dorsal ligament stiffness was 66.3 ± 18.3 newtons per millimeter and the Lisfranc ligament stiffness was 189.7 ± 57.2 newtons per millimeter. The failure load of the dorsal ligament averaged 150.7 ± 33.1 newtons and for the Lisfranc ligament, 368.8 ± 126.8 newtons. Conclusions The stiffness and load to failure of the dorsal cuneometatarsal ligament were much higher than anticipated, which indicates that it contributes significantly to stabilizing the second metatarsal to the first cuneiform.