Przejdź do treściA randomised trial with a mean follow-up of 10.8 years found no advantage to preserving the first tarsometatarsal joint (TMT1) over primary arthrodesis in selected patients with unstable Lisfranc injury. This is important because it is easy to assume that preserving a mobile joint must lead to better long-term function. In this specific patient group, that advantage was not demonstrated.
Why is this study clinically interesting?
Lisfranc injuries have long generated debate about when joint preservation should be prioritised and when primary arthrodesis is the more reasonable strategy. Most published studies have relatively short follow-up. The report by Grün and colleagues, published online on 9 July 2026 in The Journal of Bone and Joint Surgery, is a long-term continuation of an earlier randomised trial and provides a rare comparison of the two approaches more than a decade later.
Study question and methodology
The original trial enrolled 48 adults with unstable Lisfranc injuries involving the three medial tarsometatarsal joints. An important detail is that patients with a fracture involving TMT1 were not included.
- One group underwent primary arthrodesis of TMT1, TMT2 and TMT3.
- In the other group, TMT1 was preserved and temporarily stabilised with a dorsal bridge plate, while TMT2 and TMT3 were also fused.
After a mean of 10.8 years, 41 of the 48 originally randomised patients—85% of the cohort—were assessed. Outcomes included the AOFAS midfoot score, Manchester–Oxford Foot Questionnaire (MOxFQ), pain, SF-36, return to activity, use of orthoses or inserts, and degenerative changes on computed tomography.
Results
At approximately 10 years, there was no significant difference in AOFAS scores: 89.3 points after primary TMT1 arthrodesis versus 92.6 points after temporary bridge plating (p = 0.66). No significant differences were found in MOxFQ, pain, SF-36, return to activity or the need for orthotic support.
The frequency of degenerative changes in adjacent joints was similar. After TMT1 preservation, degenerative changes within TMT1 itself were common, but only one patient subsequently required arthrodesis. The bridge-plating strategy, however, involved planned removal of the fixation hardware, meaning an additional procedure that was not required after primary arthrodesis.
Clinical interpretation for an orthopaedic surgeon
The practical conclusion is not that every patient should undergo arthrodesis. The study shows something narrower and more useful: in this selected group, preserving TMT1 did not translate into a detectable functional advantage after more than 10 years. At the same time, primary fusion of the first tarsometatarsal joint did not lead to poorer function or a higher frequency of degenerative change in adjacent joints.
Imaging findings should also be separated from symptoms. Degenerative change in a preserved TMT1 was common on imaging, but this did not automatically lead to another operation; only one patient required secondary arthrodesis.
Limitations
- The study was randomised but small: 48 patients were enrolled initially and 41 were assessed at approximately 10 years.
- A non-significant statistical difference is not formal proof that the procedures are equivalent; the sample may have been too small to detect subtle differences or uncommon complications.
- TMT2 and TMT3 were fused in both groups. The findings therefore cannot be directly extrapolated to a comparison between completely joint-preserving fixation and arthrodesis of the entire medial Lisfranc complex.
- Fractures involving TMT1 were excluded, so the conclusions apply to a defined injury pattern.
- The AOFAS score is an older measure combining patient-reported elements with clinical examination. It is therefore useful that the investigators also included MOxFQ, pain and SF-36.
What may change in practice—and what the study does not prove
The study strengthens the argument that primary TMT1 arthrodesis in an appropriately selected patient with an unstable Lisfranc injury does not necessarily produce a worse long-term result simply because motion at that joint is sacrificed. Conversely, preserving TMT1 can also produce a good result despite frequent degenerative changes on imaging.
The study does not prove that arthrodesis is universally superior, does not resolve every type of Lisfranc injury and does not allow every fixation technique to be treated as equivalent to temporary dorsal bridge plating. The decision must still account for the injury pattern, condition of the articular surfaces, ability to restore the Lisfranc complex anatomically, patient activity and the consequences of a possible additional procedure.
Back to: Trauma — Literature for Clinicians
References
Grün W, Poulsen M, Riiser MØ, Hvaal K, Husebye EE, Stødle AH. A Randomized Controlled Trial of Primary Arthrodesis Versus Temporary Bridge Plating in Unstable Lisfranc Injuries: A Concise Follow-up, at 10 Years, of a Previous Report. J Bone Joint Surg Am. Published online July 9, 2026. DOI: 10.2106/JBJS.26.00020. PubMed: PMID 42424434.
Original trial: Stødle AH, Hvaal KH, Brøgger HM, Madsen JE, Husebye EE. Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial. Foot Ankle Int. 2020;41(8). DOI: 10.1177/1071100720925815.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.