Subtle lesions of the intercuneiform and tarsometarsal joints treated by neoligament plasty

Abstract

Objective: The main objective of this paper is to present the results obtained in the treatment of subtle lesions of the intercuneiform and tarsometarsal joints by a neoligament plasty. Methods: Between 1995 and 2004, 18 patients with subtle Lisfranc injuries were treated. All patients were able to confirm that they had suffered a foot sprain with the forefoot fixed to the surface. In 11 patients (61%), the accessory force acted in eversion and, in seven patients (39%), in inversion. Only nine patients (50%) showed radiographic signs that could confirm the suspicion of the clinical diagnosis. All of them had confirmation of anatomical structures involvement by the MRI. The ruptured ligaments were explored and their residue removed – one of the aims of the surgery that will control the pain and lead to the reduction of the joints. After the reduction, drill holes were made to reproduce the isometry and anatomy of the torn ligaments. In six patients, the 2 mm polidioxanone cordel (Johnson & Johnson) and, in two, the 5.0 dexon suture were used to substitute for the ligaments. In two, we used the 4th EDL and, in eight, the 3rd EDL passed as a substitute for the ligaments. Results: After an average follow-up of 5.9 years (1.3 ~ 10.2 yrs) 15 patients (83%) were considered as excellent or good results (complete recovery of motion and power; no pain; no soft tissue, or bone reaction to the neoligaments; no loss of anatomical reduction). Three patients (17%) had fair or poor results (arthritis). Conclusions: Resection torn ligaments, anatomic reduction of the subluxated joints, and isometric reconstruction of the ligaments showed to be an excellent solution to the subtle Lisfranc Injuries and an alternative to the screw fixation.