DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. X-Ray: anteroposterior (A-P), a 30-degree oblique, and a lateral view of the foot are required. In conclusion, to our knowledge, this is the largest series published to date investigating the performance of radiographs in the diagnosis of Lisfranc injury. Received 2018 Apr 26; Accepted 2018 Aug 31. 2009;28(3):3517. In addition to anteroposterior weight-bearing radiographs, lateral weight-bearing radiographs have been reported as showing flattening of the longitudinal arch in the delayed diagnosis of Lisfranc injury [3]. Knijnenberg LM, Dingemans SA, Terra MP, Struijs PAA, Schep NWL, Schepers T. Radiographic anatomy of the pediatric Lisfranc joint. . Lisfranc injuries: a matter of ligament disruption. Sixty patients were examined by CT over a 1-year period in the assessment of significant midfoot injury. Generating an ePub file may take a long time, please be patient. 2015 Nov;39(11):2215-8. doi: 10.1007/s00264-015-2939-8. Rettedal DD, Graves NC, Marshall JJ, Frush K, Vardaxis V. Reliability of ultrasound imaging in the assessment of the dorsal Lisfranc ligament. The Lisfranc ligament connects directly between the medial cuneiform and the second metatarsal (photo above). Skeletal Radiol 49, 3153 (2020). sharing sensitive information, make sure youre on a federal Foot Ankle Int. Magn Reson Imaging Clin N . . MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Pattern of the Month. The most common mechanism of injury is torsion/impaction against the plantar flexed foot (i.e., foot is pointed downward). Delfaut EM, Rosenberg ZS, Demondion X. Malalignment at the Lisfranc joint: MR features in asymptomatic patients and cadaveric specimens. Its structure is of great significance for the weight-bearing function of the foot. This is an important section for the diagnosis of Lisfranc ligament injuries. It can be summarized that the Lisfranc ligament originates at the site 12.631.20mm from the lateral side of the base of the medial cuneiform bone, has a length of 8.021.5mm, a width of 2.530.61mm, a height of 6.961.01mm, forms an included angle of 46.793.47 with the long axis of the first metatarsal bone, and finally ends at the base of the second phalanx. Methodological quality was assessed by the QUADAS-2 tool. In addition, a foot phantom was investigated to determine the optimum degree of craniocaudal angulation on the anteroposterior radiograph to best show the joint. This is an important section for the diagnosis of Lisfranc ligament injuries. Methods MRI scanning was performed on 60 sides of normal feet of 30 healthy adult volunteers. Foot (Edinb). 1Department of orthopedics, Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000 China, 2Peoples Hospital of Rizhao, Xinjiang Medical University, No. AJR Am J Roentgenol. Further research with large sample size is still needed to confirm the conclusions. Imaging for LisfrancInjury/ MidFoot Sprain The advantage of seeing your family doctor or going to a sports medicine doctor is the fact that they can order imaging for you if needed. Classification . Lundberg A, Goldie I, Kalin B, Selvik G. Kinematics of the ankle/foot camplex: plantarflexion and dorsiflexion. 1994;22(5):68791. 2018;39(3):37686. The diagnostic accuracy ofradiographs in Lisfranc injury and the potential value of a cranio-caudal projection. . Femoroacetabular Impingement: Radiographic DiagnosisWhat the Radiologist Should Know, Review. Epidemiology and outcomes of Lisfranc injuries identified at the National Football League Scouting Combine. The Lisfranc joint plays an important role in the process of walking with the lower extremities, and the so-called Lisfranc ligament is the ligament that originates from the lateral side of the medial cuneiform bone and ends at the medial side of the base of the second metatarsal bone. The CT examination was reported as either normal or positive for Lisfranc injury using the same diagnostic criteria that applied to the radiographic evaluation. The oblique crosssection can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. Skelet Radiol. Foot Ankle Clin. J Foot Ankle Res. Hence, there is no available auxiliary examination for diagnosing related injuries. Learn more about Institutional subscriptions. All seven false-negative cases were treated conservatively. Both observers did, however, apply everyday reporting evaluation and were conscious of not overcalling the radiographic findings, and this is evidenced by a relatively low number of three false-positive findings. To confirm a diagnosis of Lisfranc injury, imaging tests are most important. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. One potential effect of craniocaudal angulation is to cause foreshortening of the phalanges, potentially reducing the ability to diagnose a phalangeal fracture. AJR Am J Roentgenol. This study received funding from the National Institute for Health Research. the best planes to delineate their precise configurations are the axial and transverse oblique planes. Tafur M, Rosenberg ZS, Bencardino JT. Instr Course Lect. Am J Sports Med. 2A, 2B, 2C, and 2D). It's hard to understand what fracture would be confused for a Lisfranc injury on an x-ray then look more reassuring on MRI. A bone scan can demonstrate Lisfranc injuries that occurred 3 months before presentation and are continuing with painful weightbearing. 2012;94(14):132537. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. Early identification and meticulous management, often surgical, is required for optimal outcome as the conservative approach has been linked to poor results [2]. Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, et al. Imaging in Lisfranc injury: a systematic literature review. HHS Vulnerability Disclosure, Help The results of our study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries which extended those former studies. Google Scholar. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. In the middle region of your foot (midfoot), a cluster of small bones form an arch. Areas of disagreement were between normal and equivocal in 16 of 19 cases (84%) and between equivocal and definite in three of 19 cases (16%). McHale KJ, Vopat BG, Beaulieu-Jones BR, Sanchez G, Whalen JM, McDonald LS, et al. Screw fixation for lisfranc injury Research When Is Surgery Needed? A Lisfranc injury occurs secondary to disruption of a major stabilizing ligament of the arch of the foot. The oblique cross-section can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. The dorsal pedals best and vessel mixture must also be estimated. Imaging showed a severe Lisfranc injury, or injury to the . Although Lisfranc sprains can be difficult to detect at physical ex-amination and imaging, they can be a source of significant morbidity for athletes, with one series reporting that 18% of patients were unable to re-turn to their sport after injury (9). Only one observer was used in the assessment of the CT because we do not consider that such difficulty in interpretation applies to the CT evaluation. The remaining 25 patients were treated conservatively with cast immobilization. OBJECTIVE. A doctor will be able to evaluate the x-rays and imaging tests to determine the extent of the injury. 2016;26:305. Surgery is how the most severe Lisfranc injuries are treated. FOIA Craniocaudal angulation can better show the joint, and an angle of 28.9 is likely to optimally visualize the joint in the majority of patients. Craniocaudal angulation can better show the joint, and an angle of 28.9 is likely to optimally visualize the joint in the majority of patients. Among the potentially most debilitating midfoot injuries are Lisfranc fracture-dislocations. Treatment of Lisfranc joint injury: current concepts. Haidich AB. Our results are similar to those of Sherief et al. The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. Lisfranc injuries refer to injuries of the bones, joints, and ligaments of the Lisfranc joint, which are rare in clinical practice; accounting for approximately 0.2% of all fracture cases [9]. 2014;104(1):118. Sometimes mistaken for a sprain, a Lisfranc injury is not that simple and may require surgery . There also is a strong ligament connecting the medial cuneiform and 2nd metatarsal base called the Lisfranc ligament. Chan BY, Markhardt BK, Williams KL, Kanarek AA, Ross AB. This study aims to observe and describe the morphology and structure of Lisfranc ligaments using magnetic resonance imaging (MRI), in order to provide imaging reference for the diagnosis and repair of Lisfranc joint injuries. CT evaluation of tarsometatarsal fracture-dislocation injuries. The anatomical structure of the Lisfranc joint is complex, and the sensitivity of the X-ray film is only 84.4% [12]. All continuous variables were expressed as meanstandard deviation. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. Curr Probl Diagn Radiol. Detailed imaging parameters of the Lisfranc joint and ligament were obtained from the present imaging experiment, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries. MATERIALS AND METHODS. The institutions ethics review board did not require ethical review for this retrospective analysis of imaging data obtained as part of the patients normal clinical care. Specific scan parameters were as follows: SE/T1 WI sequence: slice thickness was 3mm; slice gap was 3mm; TR was 550ms and TE was 16ms; visual field was FOV 180180mm; matrix was 436512; and acquisition time was 3min and 35s. SE/T2 WI sequence: slice thickness was 3mm; slice gap was 3mm; TR was 3200ms and TE was 36ms; matrix was 512512; visual field was FOV 160160; and acquisition time was 3min and 54s. (4) The resulting images were burned on a disc for storage. CT examination of the phantom was obtained. A common mechanism of injury is forced plantar-flexion of the foot which can occur with missing a step when descending stairs, as described in this case. Evaluation of the radiographs was performed blind to the results of the CT examination. Recently, Thierfelder et al. A Lisfranc joint injury is a type of injury to the bones or ligaments, or both, in the middle part of your foot. This joint is the keystone to normal foot function and is thus critical for normal gait. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. The diagnosis and treatment of injuries to the Lisfranc joint complex. PubMedGoogle Scholar. Secondly, this was an observational trial without control group. A 34-year-old man presented with sudden onset of pain in his right foot after landing a jump in a handball game. These injuries are well demonstrated on the standard views of the foot. The Lisfranc midfoot joint complex has very litle motion and is critical in stabilizing the arch for push off during walking (gait). This article discusses the best available evidence for . J Foot Ankle Surg. Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC. Two of the false-positives were considered as showing definite evidence of Lisfranc injury on radiographs. Weight-bearing views can accentuate the degree of displacement at the Lisfranc joint. Imaging PubMed 2017;45(8):19018. CT scan: If you need surgery your provider or surgeon needs to know exactly how damaged your bones are. He also reviews both non-surgical and surgical considerations when dealing with Lisfranc injuries. Imagery Includes the following options X-Ray - An x-ray is excellent for seeing broken bones and the placement of dislocated bones from a lisfranc fracture. Despite the fact that both radiologists were experienced in musculoskeletal imaging, only 68.9% of cases were identified on the radiographs. 1) shows that a standard anteroposterior radiograph of the foot optimally visualizes the phalanges, which lie at a right angle to the x-ray beam. MR imaging of the midfoot including Chopart and Lisfranc joint complexes. Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. "Lisfranc" is one of the best known orthopedic eponyms. The reason is that the location of the Lisfranc ligament is deep, and its length is short; hence, its injury is more difficult to diagnose. Foot Ankle Clin. Injuries of ligaments and tendons of foot and ankle: what every radiologist should know. 1981;137(6):11516. ACR appropriateness criteria acute trauma to the foot. They are often missed (20% missed diagnosis rate) and have a frequency of 1:50,000 in foot injuries. Abnormalities of the foot and ankle: MR imaging findings. Its shape can be seen as a wedge surrounded and attached by strong ligaments, allowing it to have a small range of motion [28]. Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Part of Springer Nature. B, Anteroposterior (A) and oblique (B) radiographs of foot show subtle malalignment of second tarsal-metatarsal joint, which was considered equivocal for Lisfranc injury. Lisfranc is applied to a multitude of normal structures and various injuries: the Lisfranc joint, Lisfranc ligament, Lisfranc injury, and Lisfranc fracture-subluxation or dislocation. I Injury to the Lisfranc joint (Tarsometatarsal joint) is a rare event with reported incidence of 0.1 to 0.4% of fracture cases [1]. Pain that worsens with standing, walking or attempting to push off on the affected foot. 2017;25(7):46979. 2009;91(4):8929. The commonly used classification system described by Hardcastle et al. Radiology. All patients who underwent CT of the foot for the investigation of acute foot injury over a 1-year period were identified from our institutes PACS. Thierfelder KM, Gemescu IN, Weber MA, et al. AA have made substantial contributions to conception and design; DHY contributed to acquisition of data and analysis and interpretation of data; AA have been involved in drafting the manuscript and revising it critically for important intellectual content; LLG have given final approval of the version to be published. Please enable it to take advantage of the complete set of features! The Lisfranc joint is an important component of the foot arch structure. Deformity correction and arthrodesis of the midfoot with a medial plate. but the specialist may need to order advanced imaging such as CT or MRI scans in order to evaluate more subtle Lisfranc injuries and determine the possible need for surgical consultation. This is a relatively common, and sometimes career-ending injury in the NFL. We have spoken of the two surgical treatments below. 11 plantar ecchymosis is considered pathognomonic for a lisfranc injury. The outcomes showed that the Lisfranc ligament originates at the site 12.631.20mm from the lateral side of the base of the medial cuneiform bone, with a length of 8.021.5mm, a width of 2.530.61mm, a height of 6.961.01mm, forms an included angle of 46.793.47 with the long axis of the first metatarsal bone, and finally ends at the base of the second phalanx (Table1). Bookshelf This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. We thank Jacqueline Rowbottom for performing the phantom radiographs. Further research with large sample size is still needed to confirm the conclusions. Certain types of Lisfranc injuries require surgery. 2016;23(6):60914. Subtle capsular avulsions involving the tarsal-metatarsal joint were taken as evidence of potential Lisfranc injury. What is a Lisfranc Injury? 2018;38(10):5103. The dorsal pedals vein flow above the proximal head of the 2 nd metatarsal. Weight-bearing views, if tolerated, are strongly recommended and will help accentuate any deformities, especially for subtle Lisfranc joint diastasis. However, this preliminary research had paved the way for the further research about magnetic resonance imaging of the Lisfranc ligament. Rosenbaum A, Dellenbaugh S, Dipreta J, Uhl R. Subtle injuries to the Lisfranc joint. Foster SC, Foster RR. In a Lisfranc joint injury, there is usually damage to the cartilage covering these bones. J Am Acad Orthop Surg. Am J Sports Med. Injury pattern in ligamentous Lisfranc injuries in competitive athletes. One or more imaging tests are done to look at the bones and . Preidler KW, Brossmann J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. Lisfranc's tarsometatarsal fracture-dislocation. Subtle injuries of the Lisfranc joint. Visit ScienceDirect to see if you have access via your institution. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments. We use cookies to help provide and enhance our service and tailor content. J Bone Joint Surg Am. Olerud C, Rosendahl Y. Torsion-transmitting properties of the hind foot. 2012;198(4):W3659. Standard surgical practice is to perform open reduction and internal fixation to anatomically realign the joint when there is joint malalignment due to either dislocation or disruption of the articular surface. . [4], who tested the performance of nine senior clinicians on a set of 30 radiographs that contained 17 cases of Lisfranc injury and found that only 61% of cases were identified by all the observers. Epub 2014 May 10. The ePub format uses eBook readers, which have several "ease of reading" features lisfranc injury assessment commonly relies on one or more of the following imaging modalities: conventional (non-weightbearing or weightbearing) radiography (anteroposterior, oblique, and lateral foot views), ultrasonography (us), computed tomography (ct), and/or magnetic resonance imaging (mri) [ 7, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, Please go back to the previous page by using your browser's Back button, or visit the Home Page. J Bone Joint Surg Am. Comparison of magnetic resonance imaging with intraoperative findings. 2013;6(1):7. Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. J Am Coll Radiol. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. Coss HS, Manos RE, Buoncristiani A, Mills WJ. Unfortunately in Volume 49, Issue 1 had been published online with an incorrect date (2001 instead of 2020). Lisfranc injury is very important to recognize as it can lead to arthritis and disability if not repaired. CT scanning is particularly useful for detecting non-displaced fractures and minimal osseous subluxation. The page or action you requested has resulted in an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. AJR Am J Roentgenol. Philbin T, Rosenberg G, Sferra JJ. Calcific . Position and placement: the toe of the subject was first entered, with the planta touching the bed. common injuries in athletes. Because Lisfranc injuries are relatively rare, only representing 0.2% of all fractures, with an estimated incidence of 1/55 000 people, there continues to be an ongoing debate on the ideal management of such injuries. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. This data will not be shared, because in recent years, although many scholars have explored this in various aspects, its pathological mechanism remains unclear, and there are no standard diagnostic criteria. Tenderness over the midfoot and reproduction of pain with passive motion of the forefoot are suggestive of a Lisfranc injury. Radiographics. 12 other clinical signs that should trigger clinicians' suspicions include swelling in the mid-foot The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Goiney RC, Connell DG, Nichols DM. A Lisfranc injury must be part of the differential for any midfoot trauma because of the significant morbidity associated with missed diagnosis Physical exam findings, including deformity, swelling and ecchymosis, may be subtle or absent Normal foot x-rays do not rule out a Lisfranc injury, weight-bearing views or CT are essential Read More Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA. Ulbrich EJ, Zubler V, Sutter R, Espinosa N, Pfirrmann CW, Zanetti M. Ligaments of the Lisfranc joint in MRI: 3D-SPACE (sampling perfection with application optimized contrasts using different flip-angle evolution) sequence compared to three orthogonal proton-density fat-saturated (PD fs) sequences. Osteopoikilosis 38. official website and that any information you provide is encrypted Current concepts review: Lisfranc injuries. A, Anteroposterior (A) and oblique (B) radiographs of foot show subtle malalignment of second tarsal-metatarsal joint, which was considered equivocal for Lisfranc injury. Normal foot x-rays do not rule out a Lisfranc injury, weight-bearing views or CT are essential. Skelet Radiol. 1996;199(3):7336. By observing the obtained images of the Lisfranc ligament through appropriate MRI scanning, it was found that the Lisfranc ligament originates at the site 12.63 1.20 mm from the lateral side of the base of the medial cuneiform bone, with a length of 8.02 1.5 mm, a width of 2.53 0.61 mm, a height of 6.96 1.01 mm, forms an included angle of 46.79 3.47 with the long axis of the first metatarsal bone, and finally ends at the base of the second phalanx. An analogous situation is the wrist radiograph, where an oblique projection of the carpal and carpal-metacarpal joints would never be accepted. 1 Jacques L. Lisfranc was a French surgeon during the Napoleonic wars who described an injury to the midfoot that resulted when men fell . Imaging of Lisfranc Injury Greg Cvetanovich, Harvard Medical School Year IV Gillian Lieberman, MD November 2011 Greg Cvetanovich, MS4 Gillian Lieberman, MD 2 Agenda Skeletal Radiology Lisfranc Injury Imaging and Surgical Management. JAMA. The tarsal-metatarsal joint of the second metatarsal lies oblique to the x-ray beam on the anteroposterior radiograph, and we have shown that a craniocaudal angulation of 28.9 would optimally reveal the joint in a population of patients being investigated for midfoot injury. AJR Am J Roentgenol. Groulier P, Pinaud JC. This procedure usually involves a surgeon using permanent or temporary hardware. stephenf.hatem,md ''lisfranc'' is one of the best known orthopedic eponyms.unfortunately,thetermisimprecise.lis- franc is applied to a multitude of normal structures andvariousinjuries: thelisfrancjoint,lisfrancliga- ment,lisfrancinjury,andlisfrancfracture-subluxa- tionordislocation.jacqueslisfranc,afieldsurgeon in napolean's army, described none Ryba D, Ibrahim N, Choi J, Vardaxis V. Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging. If clinical suspicion of a Lisfranc injury persists after inconclusive radiographs; computed tomography (CT) is the next line of imaging. According to WebMD, a Lisfranc injury happens when "[an individual damages their] . MR imaging evaluation of subtle Lisfranc injuries: the midfoot sprain. 1 CT sagittal reformation of foot phantom. Foot Ankle Int. Lisfranc injuries, especially subtle injuries, can often be missed. Lisfranc injuries with <2mm of displacement can placed in a bulky dressing for 2-3 days to allow swelling to decrease, a well-padded splint or a well-padded short leg cast placed to accommodate swelling. The tarsometatarsal (TMT), or Lisfranc, joint complex is the attachment between the forefoot and midfoot. Magnetic resonance imaging (MRI) is a sensitive and specific imaging modality and should be considered in injuries with equivocal physical and radiographic findings. Kitsukawa K, Hirano T, Niki H, Tachizawa N, Nakajima Y, Hirata K. MR imaging evaluation of the Lisfranc ligament in cadaveric feet and patients with acute to chronic Lisfranc injury. You may undergo a surgical procedure called internal fixation, where the bones of your foot are repositioned and held in place with. Up to 20% of Lisfranc fracture-dislocations are misdiagnosed or missed during the initial evaluation. While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography, CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. C, Short-axis CT section through base of metatarsals shows bony avulsions (arrow) from base of second metatarsal. The angle of the joint in all 60 patients was measured on CT. There may be bruising on both the top and bottom of the foot. The most common symptoms are [13]: Swelling of the foot and/or ankle Bruising of the foot and/or ankle Pain usually in the middle part of the foot Widening of the midfoot area Large bump on the top midfoot area For disruption, this one is susceptive in a plain fracture. If it is out of alignment, it may suggest that there is injury to the ligaments in that area of the foot. Am J Sports Med. 2004;25(9):6149. Lisfranc joint injuries: trauma mechanisms and as-sociated injuries. 2009;14(2):16986. This is a very important stabilizing ligament of the foot (left). Kalia V, Fishman EK, Carrino JA, Fayad LM. This is an important section for the diagnosis of Lisfranc ligament injuries. Myerson MS, Cerrato R. Current management of tarsometatarsal injuries in the athlete. 2019 February 15; 14: 50, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://www.ncbi.nlm.nih.gov/pubmed/?term=Olerud+C%2C+Rosendahl+Y.+Torsiontransmitting+properties+of+the+hind+foot.+Clin+Orthop.+1987%3B(214)%3A285%E2%80%9394, Lisfranc distance of ligament starting point to entocuneiform base (mm), Lisfranc angle between the Lisfranc ligament and the long axis of the first metatarsal bone(). A Lisfranc injury must be part of the differential for any midfoot trauma because of the significant morbidity associated with missed diagnosis. On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. PMC J Am Podiatr Med Assoc. Since the Lisfranc ligament distributes obliquely, its display is generally poor. Based on the results of previous tests, we positioned and scanned the Lisfranc joint from the oblique cross-section parallel to the dorsal foot and oblique coronal-section parallel to the Lisfranc joint clearance, which can be just right to display the entire Lisfranc ligament and attachment points. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Lisfranc injuries are severe injuries to the tarsometatarsal (Lisfranc) joint, between the medial cuneiform and the base of the 2nd metatarsal. Each case was put into one of three diagnostic categories: normal, definite evidence of Lisfranc injury, and equivocal for Lisfranc injury. 2015;36(12):148392. The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. Hippokratia. The authors have no conflicts of interest to declare. Aerts P, Disler DG. Imaging for Lisfranc Joint Injury. An Intera Achieva 1.5-T magnetic resonance machine (PHILIPS, Holland) was used, which was equipped with a high-resolution knee coil. The initial presenting radiographs were evaluated independently by two experienced consultant musculoskeletal radiologists with a special interest in skeletal trauma. Magnetic Resonance Imaging (MRI): If ligaments, tendons or other, non-bony parts of your Lisfranc joint are injured, your provider might use an MRI to get a complete picture of your foot and any damage inside it. Some . The case notes of all patients were obtained, and the subsequent management was recorded. J Am Acad Orthop Surg. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. 2006;47(7):7107. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. The analyzed contents included the Lisfranc joint bone structure display, articular cartilage display, the display of the profile of the ligaments and muscles and attachment points, and the joint space display; the measurement and statistical analysis of imaging parameters of the Lisfranc ligament. A. Ablimit, Hui-Yong Ding, and Li-Guo Liu. We did not perform weight-bearing views because they are difficult to perform in the acute situation when the patient is not bearing weight because of pain. }, author={Eva Llopis and Javier Carrascoso and I{\~n}igo Iriarte and Mariano de Prado Serrano and Luis Cerezal}, journal={Seminars in musculoskeletal radiology}, year={2016}, volume={20 2}, pages={ 139-53 } } . Keywords: CT, diagnostic accuracy, Lisfranc injury, radiography, trauma. The radiologists in the current study were aware that all patients clinically had a significant midfoot injury and had all undergone foot CT and were therefore sensitive to the presence of Lisfranc injury. Foot Ankle Int. An Open Reduction Fixation Surgical Procedure You might need to undergo two surgeries if you need this procedure. Google Scholar, Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA, Yantarat Sripanich,Maxwell W. Weinberg,Nicola Krhenbhl,Charles L. Saltzman&Alexej Barg, Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand, Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT, 84132, USA, You can also search for this author in 1. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Timely and accurate diagnosis of the injury and early anatomical reduction 2017;38(10):11205. We cannot, therefore, apply the reference standard of examination under anesthesia to evaluate the performance of the CT. MRI has been investigated for the evaluation of Lisfranc ligamentous disruption in the absence of overt fracture on radiographs [11]. Typical signs of a Lisfranc injury include: Pain/tenderness throughout the midfoot when standing or when pressure is applied. The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. Woodward S, Jacobson JA, Femino JE, Morag Y, Fessell DP, Dong Q. Sonographic evaluation of Lisfranc ligament injuries. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. Conventional radiographs miss a significant number of cases of Lisfranc injury. Lisfranc Fracture-Dislocation 35. In particular, three-dimensional reconstruction technology has great advantages in the diagnosis of micro fractures and small dislocations of the foot. You will then receive an email that contains a secure link for resetting your password, If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. Price excludes VAT (USA)Tax calculation will be finalised during checkout. 1990;72(10):151922. Disclaimer, National Library of Medicine The Lisfranc joint injury isn't easy to be diagnosed, apart from when there is a marked swelling and radiographic changes noticeable. The mean ( SD) angle of the joint in the patients was 28.9 5.7. Barg A, Bailey T, Richter M, de Cesar Netto C, Lintz F, Burssens A, et al. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Nevertheless real-world performance of the radiograph is likely to be worse than the results achieved in this study. Despite the widespread use of CT in patients with suspected Lisfranc injury, there is a paucity of research literature on the diagnostic accuracy of radiographs and the increased diagnostic confidence provided by CT. Lu et al. CAS Traumatic disruption of the Lisfranc joint ruptures this ligament, which may be detected on a radiograph as malalignment of the base of the second metatarsal with the intermediate cuneiform and widening between the bases of the first and second metatarsals [1]. D, Postoperative radiograph following stress testing under anesthesia shows internal and K-wire fixation. During the investigation, it was apparent that the conventional foot radiographsthe anteroposterior and 45 oblique viewsdo not optimally visualize the tarsal-metatarsal joint of the second metatarsal. This injury is repaired surgically with screws, pins and occasionally surgical plates. @article{Llopis2016LisfrancII, title={Lisfranc Injury Imaging and Surgical Management. The clinical assessment is vital in recognizing a potentially significant midfoot injury in the face of negative or equivocal radiographic findings. Plain radiographic findings consistent with Lisfranc injury. After an immediate post-game report suggesting a season-ending fracture, it's possible further imaging studies did not show a more severe Lisfranc injury. You may switch to Article in classic view. Psoriatic Arthritis 40. Am J Sports Med 30 (6):871-878, 2002, with permission.) . On the 45 oblique, the first and second metatarsal bases overlap. In our study, we used the software program SPSS 20.0 to conduct the statistical analysis. The sensitivity of subtle injuries was lower than severe injuries (65.4% vs 87.1% p = 0.003).Conclusions Diagnosis of Lisfranc injury based on non-weight-bearing radiographs has moderate agreement . 1,8,24 This review aims to present the current literature and use existing knowledge to develop updated diagnostic and treatment . 2013;52(3):31923. PubMed and ScienceDirect were systematically searched. Periosteal Reaction, Pictorial Essay. Indeed, only 44.4% of the CT-positive cases went on to surgery. To arrive at a diagnosis, your doctor will determine how the injury occurred and examine the foot to determine the severity of the injury. Recently, few researches on the imaging of Lisfranc ligaments have been reported, and related imaging data are rare and no imaging reference can be used for the related diagnosis and repair operation of this tissue. Foot Ankle Int. Imaging in Lisfranc injury: a systematic literature review. A clinical and experimental study of tarsometafarsal dislocations and fracture-dislocations. Advanced spiral CT post-processing technique can comprehensively observe fractures and dislocations of the midfoot. patients will need to discuss with their doctor what treatment option would be the best choice for their specific case. 2012;41(2):12936. 2022 Springer Nature Switzerland AG. CT is performed in our institution for patients who show evidence of Lisfranc injury on radiographs and also for patients with normal radiographs where there is clinical suspicion of significant midfoot injury. An official website of the United States government. In recent years, the number of traffic accidents and falling injuries has increased, and Lisfranc joint injuries have also significantly increased. Li-Guo Liu, Phone: +86 13066068693, Email: moc.361@xkjxlougil. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. J Foot Ankle Surg. The main causes of injury are high-energy damage caused by traffic accidents and relatively low-energy damage caused by high falls [11]. Ultrasound appearance of the normal Lisfranc ligament. Lisfranc fracture-dislocations. Norfray JF, Geline RA, Steinberg RI, Galinski AW, Gilula LA. If the radiograph equivocal cases were considered as positive for Lisfranc injury, the radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, for a positive predictive value of 84.4%, a negative predictive value of 53.3%, sensitivity of 84.4%, and specificity of 53.3%. Myerson MS. Lisfranc injuries vary from mild to severe. Since the base of the first and second metatarsal bones lack the adhesion of intermetatarsal ligaments, the Lisfranc ligament plays an important role in maintaining the stability of the medial column and axial column of the foot arch. The relative performance of CT and MRI has not been systematically evaluated but it remains possible that CT could miss a purely ligamentous disruption in the absence of bony injury. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know, Original Research. . Lisfranc Joint Ligamentous Complex: MRI With Anatomic Correlation in Cadavers, Review. . The oblique cross-section can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. Delay in diagnosis is known to be associated with a poor outcome [10]. Phalangeal fractures are generally managed conservatively, so this is unlikely to be of clinical significance, but if a phalangeal fracture is suspected clinically, a standard anteroposterior radiograph of the foot should be performed. With craniocaudal angulation of greater than 20, there is increasing obliquity of the joint projected the other way. Each of the volunteers was examined and determined without deformity and foot trauma, or history of surgery and diseases that may have an impact on the results such as gout, rheumatoid, and diabetes were excluded. A sagittal slice through the second tarsal-metatarsal joint was obtained. Among these, the second metatarsal bone and third cuneiform form a mortise and tenon structure. Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. Ann Intern Med. government site. With no or small degrees of angulation, the joint appears oblique. 2010;18(12):71828. Overall, the available studies' methodological quality was satisfactory. The CT measurement of craniocaudal alignment of the second tarsal-metatarsal joint was performed, using the same technique, on the 60 patients examined for midfoot injury to determine the optimum angle of craniocaudal angulation likely to best show the joint in a population of patients presenting with midfoot injury. Google Scholar. the display of certain parts of an article in other eReaders. On a separate occasion, 8 months later, one of the observers evaluated the CT examination while blinded to the radiographic evaluation. CT was positive for Lisfranc injury in 45 cases (75%) and negative in 15 cases (25%). 1963;30:11629. Nonweightbearing radiographs in patients with a subtle Lisfranc injury. Castro M, Melao L, Canella C, Weber M, Negrao P, Trudell D, et al. Twenty degrees of craniocaudal angulation best showed the second tarsal-metatarsal joint of the phantom, and this correlated with a 20 angle measured by CT. In a more severe injury, the foot may be distorted and putting weight on it may be very painful. One of these cases on CT showed an accessory ossicle in the region of the Lisfranc ligament, which had been interpreted as an avulsion on the radiograph. Background: The objective of the present study was to assess the utility of magnetic resonance imaging for the diagnosis of an injury to the Lisfranc and adjacent ligaments and to determine whether conventionalmagnetic resonance imaging is a reliable diagnostic tool, with manual stress radiographic evaluation with the patient under anesthesia and surgical findings being used as a reference . 1999;173(6):16737. Emerg Radiol. PubMed Mahmoud S, Hamad F, Riaz M, Ahmed G, Al Ateeq M, Ibrahim T. Int Orthop. . Imaging tests are the best way to confirm a diagnosis of a Lisfranc injury. Objectives To systematically review current diagnostic imaging options for assessment of the . A total of 30 adult volunteers were enrolled. A standard foot phantom was used to assess the optimum radiographic projection. The foot was scanned in a standard position with the patient supine and the ankle in a neutral position, with the plantar surface at 90 to the horizontal. Nonossifying Fibroma 36. Epub 2015 Jul 30. Lisfranc Injury. Llopis E, Carrascoso J, Iriarte I, Serrano Mde P, Cerezal L. Semin Musculoskelet Radiol. Inability to bear weight. Epub 2016 Jun 23. An estimated 20% of all Lisfranc injuries are Preidler KW, Wang YC, Brossmann J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MR images. There were 33 male and 27 female patients (mean [ SD] age, 37.4 16.7 years; range, 1182 years). 1). Five of these long bones (the metatarsals) extend to the toes. This, of course, does not mean that no treatment is required because all CT-positive cases were treated with plaster immobilization. Despite showing injury to the Lisfranc joint, 25 patients did not undergo surgery because the treating surgeon did not consider that the degree of disruption warranted surgical fixation. Sripanich, Y., Weinberg, M.W., Krhenbhl, N. et al. Watson TS, Shurnas PS, Denker J. 1997;18(6):3515. CT was performed on a 64-MDCT scanner using 1.25-mm slice thickness. The Lisfranc joint of the foot is the articulation between the bases of the metatarsals and the cuneiforms medially and the cuboid laterally. 2015;54(5):8837. The mean CT measurement of the 60 patients was 28.9 5.7 (range, 1638). Twenty degrees of angulation was selected as the optimum by consensus opinion. 2018;319(4):38896. 1970;56(4):30324. [19] reported the MR imaging features of common osseous, tendon, and ligament abnormalities that affect the midfoot and also presented that MRI plays an important role in the early diagnosis of Lisfranc Ligament. This study shows the limited ability of radiographs in diagnosing Lisfranc injury. There was agreement between the two observers in evaluation of the radiographs in 41 of 60 cases (68%). The severity of this orthopaedic condition can range from minor to complex if many joints are involved. Conventional radiographs miss a significant number of Lisfranc injuries. There was good assessment on CT for the extent of the minor lesions that are normally obscured by overlapping projection in routine radiographs. All individual persons consented to publish their data. Clin Orthop. MeSH Scan methods are as follows: (1) the Lisfranc joint was placed in the horizontal lateral position within the coil, adjusted close to the natural state of the body to the maximum extent, and proper fixation was provided. The high rate of disagreement between the observers was mainly between the diagnosis of normal and equivocal, emphasizing the difficulty of diagnosing injury in subtle cases. Our results would suggest that a false-negative radiograph is unlikely to require surgical fixation. [6] reported the value of CT in three patients with Lisfranc injury. Therefore, no imaging reference can be used for related diagnosis and repair operations. "Footballguys is the best premium fantasy football only site on . Seo DK, Lee HS, Lee KW, Lee SK, Kim SB. Up to 20% of Lisfranc fracture-dislocations are misdiagnosed or missed during the initial evaluation. 2019:110. Christopher K Bromley, DPM, FACFAS discusses the origin of Lisfranc's naming history, basic anatomy as well as imaging evaluation to make a diagnosis of a Lisfranc joint injury. The most common symptoms of Lisfranc injury include: The top of foot may be swollen and painful. The ePub format is best viewed in the iBooks reader. Doctors will use one or more imaging tests to look at the bones and tissues in the foot before deciding treatment. Radiology. Graves NC, Rettedal DD, Marshall JJ, Frush K, Vardaxis V. Ultrasound assessment of dorsal Lisfranc ligament strain under clinically relevant loads. Many healthcare experts believe fusion is the best option for long-term pain management. We are experimenting with display styles that make it easier to read articles in PMC. Lisfrancs fracture dislocation. Wanlvenhaus A, Pretterklieber M. First tarsometatarsal joint: anatomical biomechanical study. Yu-Kai Y, Shiu-Bii L. Anatomic parameters of the Lisfranc joint complex in a radiographic and cadaveric comparison. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. This is an example of an injury to the arch of the foot involving the Lis Franc's ligament between the base of the 2nd metatarsal and the medial cuneiform bone. A Lisfranc injury is damage to the joints in the midfootthe Lisfranc joint, or tarsometatarsal articulation of the foot. Epub 2019 Jul 31. Magnetic resonance imaging of the Lisfranc ligament of the foot. Kinesiology and mechanical anatomy of the tarsal joints. The system is divided into three categories: A: total incongruity of the tarsometatarsal joint B: partial incongruity B1 medial displacement of the first metatarsal B2 lateral displacement of the lesser metatarsals (this can be partial i.e. Imaging for a Lisfranc injury may include X-rays to show any broken bones and the alignment of the Lisfranc joint complex. Angle of second tarsal-metatarsal joint to sole of foot was measured to calculate angle of joint to perpendicular, giving indication of craniocaudal angulation required to align x-ray beam with joint. This study was conducted with approval from the Ethics Committee of Second Affiliated Hospital of Xinjiang Medical University. . The eight images were assessed independently by the two observers and by consensus opinion, while blinded to the degree of angulation, and the image that best revealed the tarsal-metatarsal joint of the second metatarsal was selected. This is usually performed with a view to immediately proceeding to open reduction and internal fixation if the abduction stress proves positive. The foot phantom is a standard phantom of the commercially available type, which consists of the bones of the foot anatomically aligned and encased in plastic resin to match the shape of the soft tissues. Imaging of Lisfranc Injuries and Repairs Chase Sofiak, DO Jason Piraino, DPM Paul Wasserman, DO, MHCM Kristin Taylor, MD Chandana Kurra, MD Published: June 30, 2021 DOI: https://doi.org/10.1016/j.yacr.2021.05.002 Imaging of Lisfranc Injuries and Repairs Keywords Lisfranc Midfoot injury MSK radiology Musculoskeletal radiology 2003;8(1):6171. Lisfranc injuries in the athlete. 2008 May-Jun;37(3):115-26. doi: 10.1067/j.cpradiol.2007.08.012. Furthermore, the demonstration of bony fractures on CT is of little diagnostic difficulty to an experienced observer. Foot Ankle Int. Foot Ankle Int. https://doi.org/10.1007/s00256-019-03282-1, DOI: https://doi.org/10.1007/s00256-019-03282-1. Among these subjects, 16 were male and 14 were female, and the age of these subjects ranged within 2234years old, with an average age of 26years old. Before Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is . On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. "The Lisfranc complex is a critical joint in propulsion during walking and running. Rev Chir Orthop Reparatrice Appar Mot. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. Thirdly, the difference between MRI and other examinations remains unknown which need further research. CAS On the anteroposterior radiograph, the joint is not visualized as it lies oblique to the x-ray beam. Rankine JJ, Nicholas CM, Wells G, et al. Injury. One observer selected the 15 of craniocaudal angulation as the optimum projection for showing the second tarsal-metatarsal joint, and the other selected 20. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. The oblique cross-section can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points (Fig. New Balance Men's 813 V1 Hook and Loop Walking Shoe. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. Tarsal-metatarsal alignment was particularly assessed on the long-axis reformations aligned coronally to the foot. It is designed with a motion-control technology along with a ROLLBAR stability post system. PubMed Central Lapidus PW. Firstly, the sample size of our study was limited. This is a preview of subscription content, access via your institution. Patients present with a severe pain in the midfoot and difficulty in weight-bearing, commonly following road traffic accidents or athletic injuries. metatarsals 2-3, or complete i.e. Multiplanar reformatting was performed using the 3D software. 2011;155(8):52936. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Ankle equines & MPJ PF with the lisfranc joint engaged along an elongated lever arm -> joint is rolled over the body like when a person misses a step => Dorsal displacement from PF along the long axis when foot is anchored to ground 2. Phone: 817-697-4038 Fax: 877-409-3962. . Address correspondence to J. J. Rankine (james. Macmahon PJ, Dheer S, Raikin SM, Elias I, Morrison WB, Kavanagh EC, et al. And how can we improve? The https:// ensures that you are connecting to the In basic terms, it is a sprain of the Lisfranc ligament, also known as the oblique interosseous ligament. AJR Am J Roentgenol. The perpendicular to the plantar surface of the foot was determined, and the angle of the second tarsal-metatarsal joint to the perpendicular was recorded (Fig. Aronow MS. Joint preserving techniques for Lisfranc injury. Clin Orthop Relat Res. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. The results of the CT determined which patients were examined under anesthesia, and less than half of the patients with a positive CT were taken to the surgery department. Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc and Chopart injuries. 2014;34(2):51431. [7] reported four false-negative radiographs in 17 patients with CT-proven Lisfranc dislocation. A Lisfranc (midfoot) injury occurs when the ligaments supporting the midfoot are damaged or the bones in the midfoot (metatarsals) are broken. Best Shoes for Men. Free shipping for many products! (2) The scan axis was perpendicular to the long axis of the calcaneus and foot (sagittal section), which was parallel to dorsal foot (oblique cross-section) and parallel to the Lisfranc joint surface (oblique coronal-section), respectively. 136 of Taian Road, Rizhao, 276800 Shandong Province China, Lisfranc Ligament magnetic resonance imaging measurement data, Graphic interpretations: (1) MRI scanning images of the sagittal section; (2) MRI scanning images of the oblique transverse section, where the arrow indicates the Lisfranc ligament; (3) height measurement of the Lisfranc ligament; (4) width measurement of the Lisfranc ligament; (5) MRI images of the oblique coronal section, where the arrow indicates the Lisfranc ligament; (6) length of the measurement of the Lisfranc ligament; (7) measurement of the distance between the origin of the Lisfranc ligament and the base of the medial cuneiform bone; and (8) measurement of the included angle between the Lisfranc ligament and the long axis of the first metatarsal bone, Magnetic resonance imaging of the Lisfranc ligament. Foot Ankle Int. Previous studies have emphasized the importance of the third metatarsal bone [1416]. Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? X-rays and other imaging studies may be necessary to fully evaluate the extent of your injury. already built in. Lisfranc Injury Imaging and Surgical Management. The other case showed fractures of the second, third, and fourth metatarsals, which, on CT, were extraarticular with no evidence of involvement of the tarsal-metatarsal joints. J Ultrasound Med. This injury is diagnosed with a physical exam and various imaging scans. 8600 Rockville Pike The Lisfranc joint is an important part of the transverse arch and longitudinal arch of the foot [1]. Abduction stress radiography under anesthesia is often considered the reference standard for the diagnosis [8]. AJR Am J Roentgenol. This injury most commonly occurs via high-impact trauma (such as a car accident or fall) or sports-related situations. To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. The . The most common radiographic findings include diastasis of the base of the Reliability of the Lisfranc injury radiological classification (Myerson-modified Hardcastle classification system). During the systematic interpretation of the radiographs, it was obvious to the observers that the standard anteroposterior and oblique radiographs do not optimally visualize the second tarsal-metatarsal joint. MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament. . This was compared with the angle of the joint as measured on CT. CT is, however, favored as it will also demonstrate unsuspected associated fractures. Therefore, we conducted this study to analyze the MRI images of the Lisfranc joint in order to provide an imaging basis for the image recognition and damage diagnosis of this ligament. Wei CJ, Tsai WC, Tiu CM, Wu HT, Chiou HJ, Chang CY. 2020 Jan;49(1):31-53. doi: 10.1007/s00256-019-03282-1. The Lisfranc joint has complex structures, and articular surfaces overlap on conventional X-ray radiographs. This case outlines the use of conventional radiology, standard computerized tomography (CT), and three-dimensional CT for differential diagnosis of Lisfranc and associated midfoot injury in a 26 year-old female recreational athlete. Relatively uncommon, found in only 1 of every 55,000-60,000 people annually, Lisfranc injuries occur in the midfoot where the long bones leading up to the toes (metatarsals) connect to the bones in the arch (tarsals). The functionality is limited to basic scrolling. Injury diagnosis of the ligaments of the Lisfranc joint is more difficult, particularly for the diagnosis of the Lisfranc ligament (interosseous ligament). The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. The foot was placed in the knee coil, and sandbags were placed around the foot for fixation. Swelling is found primarily over the top of the midfoot. Introduction. This study aims to observe and describe the morphology and structure of Lisfranc ligaments using magnetic resonance imaging (MRI), in order to provide imaging reference for the diagnosis and repair of Lisfranc joint injuries. RESULTS. Goiney et al. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury. 2009;58:58394. and transmitted securely. Skelet Radiol. Os conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. Most MRI studies assessed Lisfranc ligament integrity. CONCLUSION. Leenen LP, van der Werken C. Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study. PubMed Some articles discussed multiple modalities. In this article, the mechanism and the classification of the Lisfranc joint and ligament injuries are outlined, and imaging findings of different modalities are discussed with the emphasis on MRI. Tafur et al. While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewers capacity to detect subtle Lisfranc injury by radiography. 1). Google Scholar. Unfortunately, the term is imprecise. Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. Skelet Radiol. 1987;(214):28594. 1998;19(8):53741. Its incidence is higher in male cases and is 23 times of that in female cases [10]. A potential problem with our study is in the use of CT as the reference standard. . Hansen ST, Browner BD, Jupiter JB, Levine AM, et al. Subtleties of Lisfranc fracture-dislocations. [5] investigated cadaver feet by radiographs and CT in varying degrees of lateral displacement, and one third of the cases with 2-mm dorsolateral Lisfranc dislocations could not be visualized on routine radiographs; however, they could all be noted on CT scans. On the oblique projection, the first and second tarsal-metatarsal joints overlap. Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. This site needs JavaScript to work properly. Foot Ankle Int. Signs are often more apparent on the oblique view of the foot. If the 13 equivocal cases were counted as negative for Lisfranc injury, the sensitivity reduced but the specificity increased (sensitivity, 68.9%; specificity, 80%; positive predictive value, 91.1%; negative predictive value, 46.1%). 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