Suture Button Fixation for Lisfranc Injuries: A Systematic Review

Abstract

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc injuries remain a significant but often misdiagnosed orthopaedic injury. Alongside traditional methods of surgical fixation, including arthrodesis and ORIF with screws, suture button fixation is an emerging technique. While several studies have reviewed the outcomes of Lisfranc injuries utilizing plate, screw, and k-wire constructs for arthrodesis or ORIF, there has yet to be a review of the literature focusing on suture button fixation outcomes of Lisfranc injuries. The purpose of this systematic review is to consolidate studies utilizing suture button fixation for the treatment of Lisfranc injuries. Methods: A comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases for original, English-language studies observing outcomes of Lisfranc injury until August 19, 2022. This combination search strategy employed the following keywords: ((Lisfranc OR Midfoot OR Tarsometatarsal) AND (Injury OR Instability OR Fracture OR Dislocation)) AND (ORIF OR Fixation OR Reconstruction OR suture* OR button* OR Fiber*). The quality of all included studies in this review was evaluated by a modified Coleman score. Clinical outcomes including pre and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, pre and postoperative Visual Analogue Scale (VAS) for pain, and radiographic outcomes such as diastasis were extracted from the text and figures of each study. Return to sports/duty and time to return as well as postoperative complication diagnoses and complications were also extracted from each article. Results: Of the 10 studies included, there were 186 total patients with an age range of 13-72. In every study, all patients were able to return to sport or activity with a return time averaging from 10.8-55.1 weeks. Postoperative AOFAS scores ranged from 83.5- 97 while VAS ranged from 0.6-2.5. Complications were reported in six studies at a rate of 6.7 % including two cases of diastasis, two cases of paresthesia, one case of button irritation, and one of postoperative degenerative joint disease, with no reported revisions. Conclusion: This study summarizes the current evidence regarding suture button fixation of Lisfranc injuries including return to sport, postoperative diastasis, and patient-reported outcomes. In sum, these studies found that suture button fixation shows high levels of patient-reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries. This surgical technique is advantageous as it provides a more physiologic reduction across the Lisfranc joint and reduces the need for reoperation including the removal of hardware. Further evidence such as large sample size and high-quality RCT studies is needed to draw a definitive conclusion regarding the best treatment for Lisfranc injuries.