## 1 Introduction  
The tarsometatarsal (TMT) joint complex, sometimes referred to as the Lisfranc joint, is a vital and anatomically complex joint, connecting the forefoot to the midfoot via articulations in the metatarsal and various cuneiform or cuboid bones [1, 2, 3]. The TMT joint complex can be further subdivided into the medial column (first metatarsal and medial cuneiform), middle column (second and third metatarsal and middle and lateral cuneiforms), and lateral column (fourth and fifth metatarasks and cuboid) [1, 4]. The consideration of specific midfoot columns has functional importance, as each column differs in its motion, thereby lending unique implications for injury pattern and recovery [1; 2; 4; 5]. The medial and middle columns permit only a small amount of motion, 3.5 mm in the coronal plane and 0.6 mm in the sagittal plane, respectively, and have thereby been termed \"nonessential joints\" [5; 6]. The lateral column acts as a shock absorber on uneven surfaces and permits the most motion, allowing for 13 mm of motion in the sagittal plane [2; 5]. In addition to connecting the forefoot and midfoot, the Lisfranc joint is essential for supporting the transverse arch of the foot [1; 2]. A wide variety of ligaments provide additional stability, with the Lisfranc ligament, an interosseous ligament running obliquely between the medial cuneiform and second metatarsal, being the strongest [1; 4]. As such, injury to the Lisfranc joint complex or supporting ligaments results in the destabilization of the midfoot complex and increases risk for arch collapse, gait abnormalities, and osteoarthritis [7; 8]. TMT joint complex injury occurs in 1 in 55,000 people annually, with the most common cause of symptomatic TMT complex pathology being post-traumatic arthritis followed by primary osteoarthritis [9]. Acute trauma to the TMT complex can occur via direct and indirect mechanisms, with direct injuries being high-energy traumas such as crush injuries and indirect injuries commonly having axial forces applied to a plantar flexed foot, resulting in dorsal tension failure [2; 10]. The first, second, and fourth TMT joints are the most commonly affected [9; 10; 11]. However, up to 20% of TMT joint complex injuries are underdiagnosed and subsequently untreated, implicating a need for timely diagnosis and treatment to prevent or reduce onset of post-traumatic arthritis [12]. There is active discussion regarding the optimal surgical treatment for repairing ligamentous or bony damage to the Lisfranc joint complex, with post-operative arthritis rates following open reduction and internal fixation ranging from 27% to 94% [2; 3; 6; 13]. Likewise, closed reduction and internal fixation has been associated with a high rate of repeat dislocations [14]. Primary arthrodesis has emerged as a viable option, with multiple systematic reviews and randomized control trials (RCTs) demonstrating decreased reoperation rates, fewer hardware complications, and improved patient reported outcomes (PROs) [3; 6; 13; 15]. However, there is little clarity regarding the efficacy of the various constructs utilized for arthrodesis [16; 17; 18; 19]. As such, this systematic review aimed to evaluate the biomechanical integrity of different constructs employed for arthrodesis in TMT joints through simulated use cases in human cadavers and synthetic bone models. This was accomplished through two main modalities with the primary outcome being a biomechanical analysis of the stability of various constructs as measured by failure load and joint displacement following the arthrodesis procedure. A secondary outcome was a kinematic analysis of joint motion and force distribution of the foot following arthrodesis at various joint levels. To date, no study has evaluated both construct stability and kinematic and force distribution changes following arthrodesis to provide insights regarding both the optimal fixation method and level [20].