title: Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes.
abstract: BACKGROUND
  Only few procedures for Lisfranc ligaments reconstruction to treat subtle injury of the Lisfranc joint have been reported. We have developed a novel technique for Lisfranc ligaments reconstruction, which was applied to treat chronic symptomatic subtle injuries that had failed to respond to initial treatment or were misdiagnosed. This article describes the technique and its operative outcome in a small case series.
  
  
  METHODS
  Between April 2011 and October 2013, 5 (4 male and 1 female) athletes with a mean age of 19.4 (range 17-21) years were diagnosed with chronic subtle injury of the Lisfranc joint and underwent our novel reconstructive operation. In this technique, only a bone tunnel between the medial cuneiform and the second metatarsal bone is needed for near-anatomical reconstruction of the dorsal and interosseous ligaments. All patients were evaluated before and at 1 year after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle-midfoot. In addition, the interval between surgery and return to athletic activity, defined as return to near pre-injury performance level, was investigated.
  
  
  RESULTS
  Mean duration of postoperative follow-up was 18.8 (range 12-26) months. Mean AOFAS score improved significantly from 74.6 ± 2.5 (range 71-77) preoperatively to 96.0 ± 5.5 (range 90-100) at 1 year after the operation (p < 0.01). All patients were able to return to their previous athletic activities and the interval between surgery and return to athletic activity was 16.8 ± 1.1 (range 15-18) weeks. There was no complication related to the operation.
  
  
  CONCLUSIONS
  The results of this study suggest that our technique of Lisfranc ligaments reconstruction using autologous graft is effective for athletes with chronic subtle injury.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan, miyamoto@med.teikyo-u.ac.jp.
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Ken
authors.initials: K
authors.lastname: Innami
authors.forename: Shinya
authors.initials: S
authors.lastname: Miki
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D012189:Retrospective Studies; D000068958:Return to Sport; D013639:Tarsal Bones / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D055815:Young Adult