Objective To observe the clinical efficacy of Tight Rope and screw internal fixation in the treatment of Lisfranc injury. Method A retrospective analysis was made of 43 patients with Lisfranc complex injury admitted to our hospital from July 2013 to July 2018. There were 25 cases in the screw group, aged 17-58 years, with an average age of 39.57±10.93 years; 16 males and 9 females; Myerson classification: 12 cases of type B2, 9 cases of type C1 and 4 cases of type C2. There were 18 cases in Tight Rope group, aged 21-57 years, with an average age of 37.36 ± 9.85 years; 12 males and 6 females; Myerson classification: 10 cases of type B2, 6 cases of type C1 and 2 cases of type C2. Perioperative complications, fracture healing time, VAS score and AOFAS score were observed. Result ①There was no significant difference in operative time and perioperative complications between the two groups (P > 0.05).② There was no significant difference in VAS score and AOFAS score between the two groups at 1 and 6 months after operation (P > 0.05), but there was significant difference between the two groups at 12 months after operation (P < 0.05).③ At the last follow-up, there were 8 cases of traumatic arthritis of tarsometatarsal joint in the screw group and 1 case in the Tight Rope group. The first and second instability of tarsometatarsal joint: 9 cases in screw group and 2 cases in Tight Rope group. There were significant differences between the two groups (P < 0.05). Conclusion Tight Rope is a flexible fixation for ligamentous lisfranc injuries, which not only avoid the joint stiffness caused by screws and the second operation, but also provide enough strength for ligament healing and joint stability.