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Dynamic Lisfranc Joint Repair Concept: Surgical Technique for a Synthetic Neoligamentplasty

LEVEL OF EVIDENCE: 5 SUMMARY Background. Isolated Lisfranc ligament and some other combined ligament injuries to the Lisfranc Joint Complex are frequently found in clinical practice, and surgical treatment is commonly indicated. In order to achieve favorable outcomes following the repair of Lisfranc injuries, a successful anatomical reduction is required. Various fixation methods currently exist such as screw fixation, dorsal bridge plate fixation, K-wire stabilization, primary fusion, neoligamentplasty and TightRope stabilization. Each technique has its own advantages and disadvantages. any rigid and long immobilization of a ligament is detrimental to healing and compromises its mechanical properties. Ideally, the best form to treat an articular joint involvement is to use a long-lasting implant, with flexibility that could potentially provide the proper stability allowing enough motion to achieve a more physiologic ligament healing. We describe a novel technique to reconstruct the Lisfranc injuries with pure ligament disruption using a synthetic neoligamentplasty with FiberTape InternalBraceTM (Arthrex, Naples, FL) passed through anatomic bone tunnels that mimic the original isometric position of the ligaments. Methods. We described the technique and evaluated 7 consecutive patients with midfoot ligament injury and a combination of tarsometatarsal instability and/or intercuneiform instability. Results. We found no postoperative complications, stiffness, or loss of correction. Conclusions. The innovative surgical technique present in this article is effective and eliminates the need for subsequent implant removal for lisfranc joint injuries. It could also provide a more physiologic arch deformation to interact with the environment in a more effective way, protecting the surrounding joints from excessive loads.