BIOMECHANICAL STUDY ON Lisfranc LIGAMENT RECONSTRUCTION WITH AUTOGENOUS TENDON_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUSongbo ^1,2 ,  HUANGDong ² , HUANGYongjun ² , LIUWeijie ³ , LIUXiaochun ²

1. The Third Clinical Medical College of Southern Medical University, Guangzhou Guangdong, 510630, P. R. China;
2. Department of Traumatic Surgery, Guangdong No. 2 Provincial People's Hospital;
3. Department of Orthopaedics, Guangdong Provincial Hospital of Traditional Chinese Medicine;

Corresponding?author：

HUANGDong, Email: dong-177@163.com

Keywords：

Lisfranc ligament; Tendon; Ligament reconstruction; Ankle

DOI：

10.7507/1002-1892.20160013

Video：

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Objective To explore the feasibility of Lisfranc ligament reconstruction with autogenous tendon through biomechanical testing. Methods Twelve fresh-frozen cadaveric lower limbs were prepared three sequential testing conditions:intact Lisfranc ligament (intact group), disrupted Lisfranc ligament (disrupted group), and Lisfranc ligament reconstruction (reconstruction group). Under fixing on the Bose mechanical test machine, three models were given 0-600 N axial loading in the neutral position and the plantar flexion of 30° according to the speed of 10 N/s, every 100 N load with a 1-minute interval. The medial cuneiform (C1) and the second metatarsal (M2) base displacement and the foot transverse arch height were recorded under different loads. Results In the neutral position and the plantar flexion of 30°, C1-M2 displacement and foot transverse arch height showed an increasing trend with increased load under 0-600 N axial loading. There were significant differences in C1-M2 displacement variation in 2 positions among groups (P＜0.05). In disrupted group, the C1-M2 displacement variation in neutral position was significantly lower than that in plantar flexion of 30° (t=7.392,P=0.000). In the neutral position, the foot transverse arch height variation in the disrupted group and the reconstruction group was significantly higher than that in the intact group (P＜0.05), but there was no significant difference between the disrupted group and reconstruction group (P>0.05). Conclusion Lisfranc ligament reconstruction with autogenous tendon can reduce the C1-M2 displacement variation and stabilize Lisfranc joint to a certain degree. Reconstruction of both dorsal ligament and Lisfranc ligament will not improve the buffering capacity. The C1-M2 displacement variation in the plantar flexion of 30° is more obvious than that in neutral position, so it is helpful to improve clinical diagnosis of occult Lisfranc damage.

Citation： LIUSongbo, HUANGDong, HUANGYongjun, LIUWeijie, LIUXiaochun. BIOMECHANICAL STUDY ON Lisfranc LIGAMENT RECONSTRUCTION WITH AUTOGENOUS TENDON. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 60-64. doi: 10.7507/1002-1892.20160013 Copy

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2.	Saab M. Lisfranc fracture-dislocation:an easily overlooked injury in the emergency department. Eur J Emerg Med, 2005, 12(3):143-146.
3.	Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35 Suppl 2:SB71-76.
4.	DeOrio M, Erickson M, Usuelli FG, et al. Lisfranc injuries in sport. Foot Ankle Clin, 2009, 14(2):169-186.
5.	Peicha G, Labovitz J, Seibert FJ, et al. The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study. J Bone Joint Surg (Br), 2002, 84(7):981-985.
6.	侯彥杰,閆斌,韓亞軍,等.金屬植入物內固定修復跖跗關節損傷:18例生物力學評價.中國組織工程研究, 2014, 18(35):5693-5698.
7.	Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury, 2015, 46(4):536-541.
8.	Marsland D, Belkoff SM, Solan MC. Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning. Foot Ankle Surg, 2013, 19(4):267-272.
9.	田競,周大鵬,于海龍,等.雙Endobutton治療單純Lisfranc韌帶損傷.中華創傷骨科雜志, 2012, 14(9):752-754.
10.	Nery C, Ressio C, Alloza JF. Subtle Lisfranc joint ligament lesions:surgical neoligamentplasty technique. Foot Ankle Clin, 2012, 17(3):407-416.
11.	Hirano T, Niki H, Beppu M. Newly developed anatomical and functional ligament reconstruction for the Lisfranc joint fracture dislocations:a case report. Foot Ankle Surg, 2014, 20(3):221-223.
12.	Miyamoto W, Takao M, Innami K, et al. Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes. Arch Orthop Trauma Surg, 2015, 135(8):1063-1070.
13.	Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains:Lisfranc injuries in the athlete. Am J Sports Med, 2002, 30(6):871-878.
14.	Libby B, Ersoy H, Pomeranz SJ. Imaging of the Lisfranc injury. J Surg Orthop Adv, 2015, 24(1):79-82.
15.	文藝,馮品,張暉,等.同種異體肌腱與螺釘固定修復Lisfranc關節韌帶損傷的生物力學比較研究.四川大學學報:醫學版, 2013, 44(2):222-225, 241.
16.	Solan MC, Moorman CT 3rd, Miyamoto RG, et al. Ligamentous restraints of the second tarsometatarsal joint:a biomechanical evaluation. Foot Ankle Int, 2001, 22(8):637-641.
17.	徐虎,張春禮,李明全.關節鏡下前交叉韌帶移植重建術后骨道擴大的研究進展.中國微創外科雜志, 2005, 5(5):395-396.
18.	李智堯,張磊,劉勁松,等.關節鏡下脛骨端RigidFix、股骨端IntraFix固定技術重建后交叉韌帶.中國微創外科雜志, 2014, 14(1):7-11.
19.	Weglein DG, Andersen CR, Morris RP, et al. Allograft reconstruction of the Lisfranc ligament. Foot Ankle Spec, 2015, 8(4):292-296.
20.	Johnson A, Hill K, Ward J, et al. Anatomy of the lisfranc ligament. Foot Ankel Spec, 2008, 1(1):19-23.
21.	李春光,俞光榮,李兵,等.內側楔骨與第2跖骨底間韌帶的解剖研究及臨床意義.中國臨床解剖學雜志, 2012, 30(2):119-122.

1. Salvi AE. Lisfranc Injuries:a matter of ligament disruption. J Foot Ankle Surg, 2014, 53(5):674-676.
2. Saab M. Lisfranc fracture-dislocation:an easily overlooked injury in the emergency department. Eur J Emerg Med, 2005, 12(3):143-146.
3. Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35 Suppl 2:SB71-76.
4. DeOrio M, Erickson M, Usuelli FG, et al. Lisfranc injuries in sport. Foot Ankle Clin, 2009, 14(2):169-186.
5. Peicha G, Labovitz J, Seibert FJ, et al. The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture-dislocation. An anatomical and radiological case control study. J Bone Joint Surg (Br), 2002, 84(7):981-985.
6. 侯彥杰,閆斌,韓亞軍,等.金屬植入物內固定修復跖跗關節損傷:18例生物力學評價.中國組織工程研究, 2014, 18(35):5693-5698.
7. Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury, 2015, 46(4):536-541.
8. Marsland D, Belkoff SM, Solan MC. Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning. Foot Ankle Surg, 2013, 19(4):267-272.
9. 田競,周大鵬,于海龍,等.雙Endobutton治療單純Lisfranc韌帶損傷.中華創傷骨科雜志, 2012, 14(9):752-754.
10. Nery C, Ressio C, Alloza JF. Subtle Lisfranc joint ligament lesions:surgical neoligamentplasty technique. Foot Ankle Clin, 2012, 17(3):407-416.
11. Hirano T, Niki H, Beppu M. Newly developed anatomical and functional ligament reconstruction for the Lisfranc joint fracture dislocations:a case report. Foot Ankle Surg, 2014, 20(3):221-223.
12. Miyamoto W, Takao M, Innami K, et al. Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes. Arch Orthop Trauma Surg, 2015, 135(8):1063-1070.
13. Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains:Lisfranc injuries in the athlete. Am J Sports Med, 2002, 30(6):871-878.
14. Libby B, Ersoy H, Pomeranz SJ. Imaging of the Lisfranc injury. J Surg Orthop Adv, 2015, 24(1):79-82.
15. 文藝,馮品,張暉,等.同種異體肌腱與螺釘固定修復Lisfranc關節韌帶損傷的生物力學比較研究.四川大學學報:醫學版, 2013, 44(2):222-225, 241.
16. Solan MC, Moorman CT 3rd, Miyamoto RG, et al. Ligamentous restraints of the second tarsometatarsal joint:a biomechanical evaluation. Foot Ankle Int, 2001, 22(8):637-641.
17. 徐虎,張春禮,李明全.關節鏡下前交叉韌帶移植重建術后骨道擴大的研究進展.中國微創外科雜志, 2005, 5(5):395-396.
18. 李智堯,張磊,劉勁松,等.關節鏡下脛骨端RigidFix、股骨端IntraFix固定技術重建后交叉韌帶.中國微創外科雜志, 2014, 14(1):7-11.
19. Weglein DG, Andersen CR, Morris RP, et al. Allograft reconstruction of the Lisfranc ligament. Foot Ankle Spec, 2015, 8(4):292-296.
20. Johnson A, Hill K, Ward J, et al. Anatomy of the lisfranc ligament. Foot Ankel Spec, 2008, 1(1):19-23.
21. 李春光,俞光榮,李兵,等.內側楔骨與第2跖骨底間韌帶的解剖研究及臨床意義.中國臨床解剖學雜志, 2012, 30(2):119-122.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL STUDY ON Lisfranc LIGAMENT RECONSTRUCTION WITH AUTOGENOUS TENDON

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