Joint Preserving Techniques for Lisfranc Injury

The goal in the treatment of Lisfranc injuries is to obtain and maintain anatomic reduction of the tarsometatarsal joints so that the ligaments, bones, and articular surfaces can heal in a manner that will minimize the development of symptomatic posttraumatic arthritis, maintain the normal longitudinal arch of the foot, and preserve the normal physiologic function of the midfoot. Although the extent of damage caused by the initial injury cannot be controlled, the surgeon can limit disability by optimizing the final maintained reduction; minimizing further iatrogenic bone, articular cartilage, nerve, and soft-tissue damage during surgical treatment; and providing appropriate postoperative care. This can best be obtained by appropriate surgical indications and careful surgical techniques including fixation methods such as joint bridging plates and screws placed in the anatomic locations of the Lisfranc and intercuneiform ligaments that are strong enough to maintain reduction until bone and ligament healing occur but avoid the additional articular cartilage damage caused by transarticular screws. Orthobiologics may play a role in aiding ligament and bone healing in these injuries.