Arthrodesis of the Tarsometatarsal Joint



Arthrodesis of the Tarsometatarsal Joint


J. Chris Coetzee, MD, FRCSC

Pascal Rippstein, MD


Dr. Coetzee or an immediate family member has received royalties from Arthrex, DePuy, and MMI; is a member of a speakers’ bureau or has made paid presentations on behalf of Arthrex and Tornier; serves as a paid consultant to or is an employee of Arthrex, Tornier, Zimmer, and Allosource; has stock or stock options in Tornier; has received research or institutional support from DePuy, Zimmer, and Allosource; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot & Ankle Society and the American Academy of Orthopaedic Surgeons. Dr. Rippstein or an immediate family member has received royalties from DePuy; is a member of a speakers’ bureau or has made paid presentations on behalf of DePuy; and serves as a paid consultant to or is an employee of DePuy.



INTRODUCTION


Anatomy

The unique anatomy of the tarsometatarsal (TMT) joint complex, also called the Lisfranc joint, contributes to the spectrum of injury patterns. The stability of the TMT joint complex is maintained by a combination of the wedge-shaped configuration of the metatarsal bases and their corresponding cuneiform articulations, as well as by ligamentous support (Figure 1).

The Lisfranc ligament is composed of three portions, running from the medial cuneiform to the base of the second metatarsal. The strongest part is the plantar portion of the ligament, which is the main stabilizing component of the first and second metatarsal interspace. There is very little motion at the second and third TMT joints, 10° to 20° at the fourth and fifth metatarsal-cuboid, and 5° to 10° at the first TMT joint.

The second TMT joint is recessed between the medial and lateral cuneiforms. The strong plantar ligaments “lock” the metatarsals to the midfoot.

A very important factor to remember is that Lisfranc joints have no inherent stability. The joints are flat on flat surfaces and rely on ligamentous stability to maintain reduction (compared with the inherent stability of a ball-and-socket joint).


PATIENT SELECTION




Feb 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Arthrodesis of the Tarsometatarsal Joint
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