Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2025; 16(3): 97830
Published online Mar 18, 2025. doi: 10.5312/wjo.v16.i3.97830
High rates of return to sport following suture button fixation for ligamentous Lisfranc injuries: A systematic review
Ragul Rajivan, James J Butler, Rachel LF Fur, Wendell Cole, Brittany DeClouette, Luilly Vargas, Sebastian Krebsbach, John G Kennedy
Ragul Rajivan, James J Butler, Wendell Cole, Brittany DeClouette, Luilly Vargas, Sebastian Krebsbach, John G Kennedy, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10002, United States
Rachel LF Fur, Department of Medicine, Royal College of Surgeons in Ireland, Dublin D02 YN77, Leinster, Ireland
Author contributions: Rajivan R, Butler JJ, Fur RLF, Cole W, DeClouette B, Vargas L, Krebsbach S, Kennedy JG designed the research study; Rajivan R, Butler J, Fur RLF extracted the data; Rajivan R, Cole W, DeClouette B, Vargas L analyzed the data; Rajivan R, Butler J, Krebsbach S wrote the first draft of the manuscript; Kennedy JG and Vargas L edited the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: John G. Kennedy is a consultant for Arteriocyte, In2Bones, and Arthrex. John G. Kennedy receives financial support from the Ohnell Family Foundation, Mr Winston Fisher and Ms Tatiana Rybak.
PRISMA 2009 Checklist statement: the authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John G Kennedy, FRCS, MCh, MD, MSc, Chief, Professor, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, New York, NY 10002, United States. john.kennedy@nyulangone.org
Received: June 10, 2024
Revised: October 14, 2024
Accepted: November 13, 2024
Published online: March 18, 2025
Processing time: 274 Days and 8.8 Hours
Abstract
BACKGROUND

The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.

AIM

To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.

METHODS

During March 2024, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed.

RESULTS

Eight studies were included. In total, 94 patients (94 feet) underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2 ± 10.2 months. The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2 ± 11.8 preoperatively to a post-operative score of 82.8 ± 5.4. The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7 ± 0.6 preoperatively to a post-operative score of 2.0 ± 0.4. In total, 100% of patients returned to sport at a mean time of 16.8 weeks. The complication rate was 5%, the most common complication of which was residual midfoot stiffness (3.0%). No failures nor secondary surgical procedures were recorded.

CONCLUSION

This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up. In addition, there was an excellent return-to-sport rate (100%) at a weighted mean time of 16.8 weeks. This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries; however, caution should be taken when evaluating this data in light of the lack of high quality, comparative studies, and short-term follow-up.

Keywords: Lisfranc joint; Suture button fixation; Systematic review; Tarsometatarsal joint; Midfoot; Ligamentous Lisfranc injuries

Core Tip: Suture button fixation for ligamentous Lisfranc injuries yields promising short-term clinical outcomes and facilitates a swift return to sporting activities. Despite its low complication and failure rates compared to traditional rigid fixation methods, caution is warranted due to the absence of high-quality comparative studies and limited long-term follow-up data. Further research with larger sample sizes and standardized outcome measures is necessary to validate these findings and assess the procedure's long-term efficacy.