Methods MRI scanning was performed on 60 sides of normal feet of 30 healthy adult volunteers. Imaging On the 45 oblique, the first and second metatarsal bases overlap. 2003;8(1):6171. . 2010;18(12):71828. Abduction stress radiography under anesthesia is often considered the reference standard for the diagnosis [8]. 11 plantar ecchymosis is considered pathognomonic for a lisfranc injury. Google Scholar. Hippokratia. 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. [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. . One potential effect of craniocaudal angulation is to cause foreshortening of the phalanges, potentially reducing the ability to diagnose a phalangeal fracture. In the middle region of your foot (midfoot), a cluster of small bones form an arch. . Accessibility The Lisfranc Joint There are actually multiple joints in the Lisfranc joint, with five metatarsal bones, three cuneiform bones and a cuboid bone. JAMA. (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. Lisfranc injury is very important to recognize as it can lead to arthritis and disability if not repaired. However, this preliminary research had paved the way for the further research about magnetic resonance imaging of the Lisfranc ligament. Groulier P, Pinaud JC. Part of Springer Nature. PubMed The CT examination was reported as either normal or positive for Lisfranc injury using the same diagnostic criteria that applied to the radiographic evaluation. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Foot Ankle Clin. J Pediatr Orthop. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. https://doi.org/10.1007/s00256-019-03282-1. 1 CT sagittal reformation of foot phantom. CT scan: If you need surgery your provider or surgeon needs to know exactly how damaged your bones are. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. 2015;12(6):57581. The examination was loaded into the PACS 3D software package (Voxar, Toshiba Medical Systems), which allows multiplanar reformatting in any plane. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. They are more commonly used in the case of delayed diagnosis. Further research is required to evaluate the performance of the craniocaudal view in the diagnosis of Lisfranc injury. Preidler KW, Brossmann J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. Gupta RT, Wadhwa RP, Learch TJ, Herwick SM. To update your cookie settings, please visit the, A single title electronic subscription for their institution, please visit, Online access for their staff to a customized collection, please visit. EXTERNAL ROTATION on a pronated forefoot (makes the MOST unstable injuries) 1970;56(4):30324. 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. Some . C, Short-axis CT section through base of metatarsals shows bony avulsions (arrow) from base of second metatarsal. Foot Ankle Int. Overall, the available studies' methodological quality was satisfactory. Weatherford BM, Anderson JG, Bohay DR. Management of tarsometatarsal joint injuries. Rev Chir Orthop Reparatrice Appar Mot. features of Lisfranc injuries and identify their typical imaging findings on radiographs, CT, and MR imaging. X-Ray: anteroposterior (A-P), a 30-degree oblique, and a lateral view of the foot are required. Recently, Thierfelder et al. It consists of three parts: the medial column, which consists of the first cuneiform and first metatarsal base; the axial column, which consists of the second and third metatarsal bones and the second and third metatarsal bases. Incidence Increased incidence in athletes secondary to greater appreciation and recognition Four percent of college football players per year An Open Reduction Fixation Surgical Procedure You might need to undergo two surgeries if you need this procedure. 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. Correspondence to Unfortunately, injuries there are easily . This study was conducted with approval from the Ethics Committee of Second Affiliated Hospital of Xinjiang Medical University. The https:// ensures that you are connecting to the [6] reported the value of CT in three patients with Lisfranc injury. The Lisfranc joint of the foot is the articulation between the bases of the metatarsals and the cuneiforms medially and the cuboid laterally. Tarso-metatarsal dislocations (10 cases). Disclaimer, National Library of Medicine Foot Ankle Int. Nonossifying Fibroma 36. All continuous variables were expressed as meanstandard deviation. We have shown that craniocaudal angulation better shows this joint. The key to diagnosing subtle Lisfranc injury lies in recognizing minimal malalignment of the second tarsal-metatarsal joint. Siddiqui NA, Galizia MS, Almusa E, Omar IM. Wanlvenhaus A, Pretterklieber M. First tarsometatarsal joint: anatomical biomechanical study. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. CAS Rankine JJ, Nicholas CM, Wells G, et al. AJR Am J Roentgenol. 1963;30:11629. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. 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. Nonweightbearing radiographs in patients with a subtle Lisfranc injury. The mechanism of injury was a twisting inversion injury in 25 cases, fall from a height in 11 cases, direct blow to the foot in six cases, a crush injury in six cases, three contact sports and two noncontact sports injuries, two cases of kicking an immovable object, four road traffic accidents (one motorcyclist and three pedestrians), and one case of injury sustained during an epileptic seizure. There also is a strong ligament connecting the medial cuneiform and 2nd metatarsal base called the Lisfranc ligament. and transmitted securely. Sports fans have heard a lot about football players with Lisfranc injuries recently. 1998;19(7):43846. J Am Acad Orthop Surg. Deformity correction and arthrodesis of the midfoot with a medial plate. Methodological quality was assessed by the QUADAS-2 tool. 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). On the anteroposterior radiograph, the joint is not visualized as it lies oblique to the x-ray beam. Norfray JF, Geline RA, Steinberg RI, Galinski AW, Gilula LA. the clinical presentation of lisfranc injuries is as diverse as the possible mechanisms, and a high degree of clinical suspicion is often needed to diagnose subtle injuries. Firstly, the sample size of our study was limited. Desmond EA, Chou LB. Lisfranc Injury Imaging and Surgical Management. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). MR imaging evaluation of subtle Lisfranc injuries: the midfoot sprain. Patients present with a severe pain in the midfoot and difficulty in weight-bearing, commonly following road traffic accidents or athletic injuries. volume49,pages 3153 (2020)Cite this article, A Correction to this article was published on 27 December 2019. Foot (Edinb). official website and that any information you provide is encrypted 2015 Nov;39(11):2215-8. doi: 10.1007/s00264-015-2939-8. Skelet Radiol. @article{Llopis2016LisfrancII, title={Lisfranc Injury Imaging and Surgical Management. Inability to bear weight. On the oblique projection, the first and second tarsal-metatarsal joints overlap. Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. Would you like email updates of new search results? [2] showed that, in almost all cases, the injury involves disruption of the second tarsal-metatarsal joint. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. 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]. The authors have no conflicts of interest to declare. PubMed Central DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. Hence, the imaging parameters of the Lisfranc ligament were acquired, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries. Kaicker J, Zajac M, Shergill R, Choudur HN. Goiney RC, Connell DG, Nichols DM. Early identification and meticulous management, often surgical, is required for optimal outcome as the conservative approach has been linked to poor results [2]. 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]. All authors read and approved the final manuscript. The main causes of injury are high-energy damage caused by traffic accidents and relatively low-energy damage caused by high falls [11]. There was good assessment on CT for the extent of the minor lesions that are normally obscured by overlapping projection in routine radiographs. 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 occurs secondary to disruption of a major stabilizing ligament of the arch of the foot. Learn more about Institutional subscriptions. Kalia V, Fishman EK, Carrino JA, Fayad LM. 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. Rankine JJ, Nicholas CM, Wells G, Barron DA. With craniocaudal angulation of greater than 20, there is increasing obliquity of the joint projected the other way. Knijnenberg LM, Dingemans SA, Terra MP, Struijs PAA, Schep NWL, Schepers T. Radiographic anatomy of the pediatric Lisfranc joint. 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. Image analysis was performed by three physicians who had a chief physician title. Magnetic resonance imaging (MRI) is a sensitive and specific imaging modality and should be considered in injuries with equivocal physical and radiographic findings. You may notice problems with 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. And how can we improve? According to WebMD, a Lisfranc injury happens when "[an individual damages their] . Epub 2019 Jul 31. Meta-analysis in medical research. Imaging showed a severe Lisfranc injury, or injury to the . Foot Ankle Int. 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 initial presenting radiographs were evaluated independently by two experienced consultant musculoskeletal radiologists with a special interest in skeletal trauma. The dorsal pedals vein flow above the proximal head of the 2 nd metatarsal. Aerts P, Disler DG. Weight-bearing views, if tolerated, are strongly recommended and will help accentuate any deformities, especially for subtle Lisfranc joint diastasis. 2014;34(2):51431. 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. 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%). 1990;72(10):151922. Myerson MS. Imaging in Lisfranc injury: a systematic literature review. Unfortunately, the term is imprecise. There may be bruising on both the top and bottom of the foot. You may switch to Article in classic view. A sagittal slice through the second tarsal-metatarsal joint was obtained. OBJECTIVE. J Ultrasound Med. Five of these long bones (the metatarsals) extend to the toes. 1 Jacques L. Lisfranc was a French surgeon during the Napoleonic wars who described an injury to the midfoot that resulted when men fell . The same features described for the radiographs were evaluated on the CT examination. Its incidence is higher in male cases and is 23 times of that in female cases [10]. Some studies recommend immobilization in a short-leg non-weight bearing cast for an additional 4-6 weeks. 2013;6(1):7. 1985;144(5):98590. 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. "Lisfranc" is one of the best known orthopedic eponyms. The outcomes of our study showed that 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. 2001;22(8):63741. PMC We are experimenting with display styles that make it easier to read articles in PMC. The commonly used classification system described by Hardcastle et al. 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. . already built in. Curr Probl Diagn Radiol. 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. The anteroposterior radiograph should be the optimum projection for revealing subtle avulsions and lateral displacement, but the joint lies oblique to the x-ray beam. 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. Marshall JJ, Graves NC, Rettedal DD, Frush K, Vardaxis V. Ultrasound assessment of bilateral symmetry in dorsal Lisfranc ligament. Common examples would include being involved in a motor vehicle accident or forklift accident, when . Delfaut EM, Rosenberg ZS, Demondion X. Malalignment at the Lisfranc joint: MR features in asymptomatic patients and cadaveric specimens. 1). 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. 2009;91(4):8929. 1996;199(3):7336. Yu-Kai Y, Shiu-Bii L. Anatomic parameters of the Lisfranc joint complex in a radiographic and cadaveric comparison. [7] reported four false-negative radiographs in 17 patients with CT-proven Lisfranc dislocation. The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. Sixty patients were examined by CT over a 1-year period in the assessment of significant midfoot injury. 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. Cite This Abstract Chakarun, C, Tumyan, L, Wolfson, N, White, E, Forrester, D, Lisfranc Fracture Dislocation: Imaging Findings with Intraoperative Correlation, and Postoperative Imaging Follow-up. A Lisfranc joint injury is a type of injury to the bones or ligaments, or both, in the middle part of your foot. Skelet Radiol. The Lisfranc ligament connects directly between the medial cuneiform and the second metatarsal (photo above). A potential problem with our study is in the use of CT as the reference standard. In order to determine the effective method for preventing and treating this disease, it is necessary to proceed with more large-scale clinical studies. 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. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. The case notes of all patients were obtained, and the subsequent management was recorded. 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. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. 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. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. 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 . A high index of suspicion should be kept based on the mechanism of injury and the presentation as above as approximately 20% Lisfranc injuries can be missed despite appropriate assessment and plain radiographs. Normal foot x-rays do not rule out a Lisfranc injury, weight-bearing views or CT are essential. 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. On a separate occasion, 8 months later, one of the observers evaluated the CT examination while blinded to the radiographic evaluation. Please go back to the previous page by using your browser's Back button, or visit the Home Page. [emailprotected]nhs.uk). Macmahon PJ, Dheer S, Raikin SM, Elias I, Morrison WB, Kavanagh EC, et al. 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. Examples of an equivocal radiograph include the presence of a metatarsal fracture where there was doubt as to whether it extended proximally to involve the tarsal-metatarsal joint, possible acute capsular avulsions in the presence of normal joint alignment, and subtle cases of possible malalignment. The diagnosis and treatment of injuries to the Lisfranc joint complex. The severity of this orthopaedic condition can range from minor to complex if many joints are involved. Science supports Xinjiang projects plan project of Xinjiang Uygur Autonomous Region (Title: Applied anatomy and biomechanical research to plantar tarsal joint stability maintenance structure) project number: 2013911112. [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. Before Treatment of Lisfranc joint injury: current concepts. Bone scanning is best used for suspected acute and chronic injuries of the TMT joints. Watson TS, Shurnas PS, Denker J. There were seven false-negative and three false-positive radiographs. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Google Scholar. 12 other clinical signs that should trigger clinicians' suspicions include swelling in the mid-foot 2016 Apr;20(2):139-53. doi: 10.1055/s-0036-1581119. Skelet Radiol. FOIA 1997;18(6):3515. 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%). J Foot Ankle Res. This article discusses the best available evidence for . 2014 Sep-Oct;53(5):674-6. doi: 10.1053/j.jfas.2014.03.021. Skeletal Radiology Secondly, this was an observational trial without control group. Learn in-depth information on Lisfranc Fracture, its causes, symptoms, diagnosis, complications, treatment, prevention, and prognosis. After acquisition of MRI images, data were burned into a CD, and the morphology and structure of the Lisfranc ligament on the MRI image were observed and described. patients will need to discuss with their doctor what treatment option would be the best choice for their specific case. B, Anteroposterior (A) and oblique (B) radiographs of foot show subtle malalignment of second tarsal-metatarsal joint, which was considered equivocal for Lisfranc injury. 2010;14(Suppl 1):2937. 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. To confirm a diagnosis of Lisfranc injury, imaging tests are most important. metatarsals 2-3, or complete i.e. Lisfranc fracture-dislocation can have subtle imaging findings, and suspicion warrants stress views or further evaluation by CT or MRI. Lisfranc injuries vary from mild to severe. The bit line should regard the fifth metatarsal base as the reference point. A clinical and experimental study of tarsometafarsal dislocations and fracture-dislocations. Multiplanar reformatting was performed using the 3D software. Address correspondence to J. J. Rankine (james. 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. To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. Nevertheless real-world performance of the radiograph is likely to be worse than the results achieved in this study. One or more imaging tests are done to look at the bones and . Psoriatic Arthritis 40. Best Shoes for Men. 2015;36(12):148392. CAS 1999;173(6):16737. . Myerson MS, Cerrato R. Current management of tarsometatarsal injuries in the athlete. The CT measurement of the phantom showed 20 angulation of the joint. 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 8600 Rockville Pike PubMed Alexej Barg. Ivory Vertebra 41. 2014;104(1):118. 2017;38(10):11205. Conventional radiographs miss a significant number of Lisfranc injuries. The angle of the joint in patients with midfoot injury was investigated to determine the optimum degree of craniocaudal angulation. Epub 2014 May 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. 1,8,24 This review aims to present the current literature and use existing knowledge to develop updated diagnostic and treatment . 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. This injury is diagnosed with a physical exam and various imaging scans. Crim, J. Kinesiology and mechanical anatomy of the tarsal joints. Tafur M, Rosenberg ZS, Bencardino JT. Kalia V, Fishman EK, Carrino JA, Fayad LM . Radiographs of the phantom were obtained, using a standard digital radiographic system, with the standard AP foot projection and at increments of 5 of craniocaudal tube angulation up to 35. Patients were treated in one of three ways: conservative treatment, which involved plaster immobilization; examination under anesthesia without surgical fixation, if no instability was found on stress testing; and open reduction and internal fixation in the presence of instability. A bone scan can demonstrate Lisfranc injuries that occurred 3 months before presentation and are continuing with painful weightbearing. Find many great new & used options and get the best deals for Musculoskeletal Imaging: Case Review Series at the best online prices at eBay! Twenty of the 45 CT-positive cases (44.4%) were taken to the surgery department. There were 33 male and 27 female patients (mean [ SD] age, 37.4 16.7 years; range, 1182 years). The Diagnostic Accuracy of Radiographs in Lisfranc Injury and the Potential Value of a Craniocaudal Projection, Evaluation of the Craniocaudal View: Phantom Study, Original Research. Hui-Yong Ding, Email: moc.361@50gnoyiuh_d. Further research with large sample size is still needed to confirm the conclusions. You may undergo a surgical procedure called internal fixation, where the bones of your foot are repositioned and held in place with. Conversely, there were two false-positive CT examinations in our series, but false-positives have also been described with MRI [11]. It is designed with a motion-control technology along with a ROLLBAR stability post system. Li-Guo Liu, Phone: +86 13066068693, Email: moc.361@xkjxlougil. . Our results are similar to those of Sherief et al. Further research with large sample size is still needed to confirm the conclusions. Lisfranc injuries are most often caused by hyperplantar-flexion of the foot, often during a sporting injury or in high-speed motor vehicle collisions. The current study was undertaken to gain a more detailed knowledge of the imaging anatomy of the Lisfranc articulation, because such knowledge is a precondition to a more precise and reliable diagnosis of its injuries. Preidler KW, Wang YC, Brossmann J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MR images. Subtle injuries of the Lisfranc joint. In the MRI scanning on the Lisfranc joint, sagittal scanning was focused on the area between the lateral margin and medial margin of the Lisfranc joint, while oblique coronal scanning was focused on the area parallel to the Lisfranc joint clearance. Llopis E, Carrascoso J, Iriarte I, Serrano Mde P, Cerezal L. Semin Musculoskelet Radiol. Among the potentially most debilitating midfoot injuries are Lisfranc fracture-dislocations. [18] reviewed the anatomy for each ligament complex or tendon, followed by relevant facts on biomechanics and typical findings in case of injury and confirmed that magnetic resonance imaging (MRI) is invaluable regarding the correct assessment of (partial) ruptures, as well as for evaluating accompanying injuries. Goiney et al. Lisfranc injuries are severe injuries to the tarsometatarsal (Lisfranc) joint, between the medial cuneiform and the base of the 2nd metatarsal. The most common radiographic findings include diastasis of the base of the The functionality is limited to basic scrolling. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. 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. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Pattern of the Month. Abnormalities of the foot and ankle: MR imaging findings. 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. Written informed consent was obtained from all participants. For disruption, this one is susceptive in a plain fracture. Imaging in Lisfranc injury: a systematic literature review. . Twenty percent misdiagnosed at initial presentation, with 40% receiving no treatment in the first week. 2022 Springer Nature Switzerland AG. CT scanning is particularly useful for detecting non-displaced fractures and minimal osseous subluxation. 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. Mahmoud S, Hamad F, Riaz M, Ahmed G, Al Ateeq M, Ibrahim T. Int Orthop. Classification . 2020 Jan;49(1):31-53. doi: 10.1007/s00256-019-03282-1. A 34-year-old man presented with sudden onset of pain in his right foot after landing a jump in a handball game. [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. Maurice Drew-Jones, running back for the Jacksonville Jaguars and Santonio Holmes, receiver for the New York Jets, have been in the news. 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. Magn Reson Imaging Clin N . Os conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. 2009;14(2):16986. Barg A, Bailey T, Richter M, de Cesar Netto C, Lintz F, Burssens A, et al. The . Ryba D, Ibrahim N, Choi J, Vardaxis V. Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. See J Orthop Surg Res. Radiographics. Imaging for a Lisfranc injury may include X-rays to show any broken bones and the alignment of the Lisfranc joint complex. 2016;23(6):60914. 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. Graves NC, Rettedal DD, Marshall JJ, Frush K, Vardaxis V. Ultrasound assessment of dorsal Lisfranc ligament strain under clinically relevant loads. (3) Main parameters: T1-vibe was set as the T1 contrast sequence, and FLASH was set as the T2 check sequence. 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. Solan MC, Moorman CT 3rd, Miyamoto RG, Jasper LE, Belkoff SM. With no or small degrees of angulation, the joint appears oblique. There was agreement between the two observers in evaluation of the radiographs in 41 of 60 cases (68%). At present, few studies on the imaging of Lisfranc ligaments have been reported, and related imaging data are rare. Calcific . Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? This is a very important stabilizing ligament of the foot (left). A total of 30 adult volunteers were enrolled. Foot Ankle Int. All seven false-negative cases were treated conservatively. Diagnosis can be made with plain film radiographs . Rettedal DD, Graves NC, Marshall JJ, Frush K, Vardaxis V. Reliability of ultrasound imaging in the assessment of the dorsal Lisfranc ligament. 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]. These injuries are well demonstrated on the standard views of the foot. This study received funding from the National Institute for Health Research. 1976;120(1):7983. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. 2011;155(8):52936. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. Jeffreys TE. This is an important section for the diagnosis of Lisfranc ligament injuries. Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. An Intera Achieva 1.5-T magnetic resonance machine (PHILIPS, Holland) was used, which was equipped with a high-resolution knee coil. Philbin T, Rosenberg G, Sferra JJ. Generating an ePub file may take a long time, please be patient. What is a Lisfranc Injury? This is one of the best shoes for Lisfranc injury because it offers a smooth and steady stride. In a Lisfranc joint injury, there is usually damage to the cartilage covering these bones. 2018;39(3):37686. Clipboard, Search History, and several other advanced features are temporarily unavailable. Lisfranc joint injuries: trauma mechanisms and as-sociated injuries. Up to 20% of Lisfranc fracture-dislocations are misdiagnosed or missed during the initial evaluation. Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Instr Course Lect. A Lisfranc injury is an injury of the midfoot that can cause pain and impair your ability to walk. Foot Ankle Int. 2006;47(7):7107. CT is, however, favored as it will also demonstrate unsuspected associated fractures. This is an important section for the diagnosis of Lisfranc ligament injuries. The dorsal pedals best and vessel mixture must also be estimated. This is an important section for the diagnosis of Lisfranc ligament injuries. Keywords: CT, diagnostic accuracy, Lisfranc injury, radiography, trauma. Price excludes VAT (USA)Tax calculation will be finalised during checkout. A Lisfranc (midfoot) injury occurs when the ligaments supporting the midfoot are damaged or the bones in the midfoot (metatarsals) are broken. MR imaging of the midfoot including Chopart and Lisfranc joint complexes. (2008). Finally, the angle of the joint was measured on the CT examinations of patients with midfoot injury to determine the optimum degree of craniocaudal angulation that would best show the joint on a population of patients being investigated for Lisfranc injury. 2016;26:305. The Lisfranc ligament, Lisfranc, Magnetic resonance imaging, Oblique coronal, 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, Journal of Orthopaedic Surgery and Research. 1996;167(5):121722. If it is out of alignment, it may suggest that there is injury to the ligaments in that area of the foot. This is a preview of subscription content, access via your institution. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Sometimes mistaken for a sprain, a Lisfranc injury is not that simple and may require surgery . 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. There were 60 patients for whom CT of the foot had been performed. J Orthop Surg Res. Visit ScienceDirect to see if you have access via your institution. 2012;198(4):W3659. Injuries of ligaments and tendons of foot and ankle: what every radiologist should know. Signs are often more apparent on the oblique view of the foot. A Lisfranc injury must be part of the differential for any midfoot trauma because of the significant morbidity associated with missed diagnosis. Chan BY, Markhardt BK, Williams KL, Kanarek AA, Ross AB. This study was conducted in accordance with the declaration of Helsinki. Skeletal Radiol 49, 3153 (2020). This article has been corrected. Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, et al. Lisfranc injuries in the athlete. Current concepts review: Lisfranc injuries. Google Scholar. 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. 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. Magnetic resonance imaging of the Lisfranc ligament of the foot. The image obtained can clearly show the image of the ligament, providing a reliable basis for auxiliary diagnosis [13]. Physical exam findings, including deformity, swelling and ecchymosis, may be subtle or absent. 2012;41(2):12936. This is usually performed with a view to immediately proceeding to open reduction and internal fixation if the abduction stress proves positive. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Therefore, it is of great significance to read the MRI images of the Lisfranc joint in detail, in order to obtain data for auxiliary diagnosis. They are often missed (20% missed diagnosis rate) and have a frequency of 1:50,000 in foot injuries. J Am Coll Radiol. Therefore, misdiagnosis and missed diagnosis easily occur. 2019:110. 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. We use cookies to help provide and enhance our service and tailor content. 2013;42(3):399409. 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, . In our study, we used the software program SPSS 20.0 to conduct the statistical analysis. AJR Am J Roentgenol. Each case was put into one of three diagnostic categories: normal, definite evidence of Lisfranc injury, and equivocal for Lisfranc injury. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. The remaining 25 patients were treated conservatively with cast immobilization. This injury most commonly occurs via high-impact trauma (such as a car accident or fall) or sports-related situations. 2002;30(6):8718. 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. }, 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 } } . Bethesda, MD 20894, Web Policies Ann Intern Med. Foster SC, Foster RR. A standard foot phantom was used to assess the optimum radiographic projection. 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. In a more severe injury, the foot may be distorted and putting weight on it may be very painful. PubMed Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know, Original Research. The mean CT measurement of the 60 patients was 28.9 5.7 (range, 1638). Hansen ST, Browner BD, Jupiter JB, Levine AM, et al. 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. Misdiagnosis, missed diagnosis, and untimely or improper treatment often leads to the instability of the Lisfranc joint or even the formation of traumatic arthritis of the Lisfranc joint. 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]. Plain radiographic findings consistent with Lisfranc injury. Typical signs of a Lisfranc injury include: Pain/tenderness throughout the midfoot when standing or when pressure is applied. Complications of missed or untreated Lisfranc injuries. Doctors will use one or more imaging tests to look at the bones and tissues in the foot before deciding treatment. 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. A Lisfranc injury is damage to the joints in the midfootthe Lisfranc joint, or tarsometatarsal articulation of the foot. CT was positive for Lisfranc injury in 45 cases (75%) and negative in 15 cases (25%). HHS Vulnerability Disclosure, Help A Lisfranc joint injury involves a type of injury to the bones and/or ligaments, in the central area of the foot. Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is . 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). The Lisfranc joint is an important component of the foot arch structure. . Aronow MS. Joint preserving techniques for Lisfranc injury. McHale KJ, Vopat BG, Beaulieu-Jones BR, Sanchez G, Whalen JM, McDonald LS, et al. AJR Am J Roentgenol. A, Anteroposterior (A) and oblique (B) radiographs of foot show subtle malalignment of second tarsal-metatarsal joint, which was considered equivocal for Lisfranc injury. Imaging tests are the best way to confirm a diagnosis of a Lisfranc injury. Acta Radiol. Certain athletes can acquire this injury if their sport involves their foot being . This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. Where there was disagreement between the two observers, the films were reviewed and a consensus opinion was obtained. The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR Am J Roentgenol. 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. CT evaluation of tarsometatarsal fracture-dislocation injuries. 1. Pain that worsens with standing, walking or attempting to push off on the affected foot. Foot Ankle Int. Lisfranc injuries, especially subtle injuries, can often be missed. 2018;38(10):5103. One case considered equivocal on radiographic evaluation was treated with internal fixation (Figs. PubMed Central J Bone Joint Surg Am. The sagittal CT section of the phantom (Fig. Most MRI studies assessed Lisfranc ligament integrity. The most common mechanism of injury is torsion/impaction against the plantar flexed foot (i.e., foot is pointed downward). Reassuringly, all seven false-negative cases were treated by plaster immobilization without surgery. ACR appropriateness criteria acute trauma to the foot. Because it is well recognized that radiographs can be very subtle in Lisfranc injury, we used two experienced observers in the assessment of the radiographs. "The Lisfranc complex is a critical joint in propulsion during walking and running. Received 2018 Apr 26; Accepted 2018 Aug 31. https://doi.org/10.1007/s00256-019-03282-1, DOI: https://doi.org/10.1007/s00256-019-03282-1. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. Epidemiology and outcomes of Lisfranc injuries identified at the National Football League Scouting Combine. 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. Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. 2015;54(5):8837. Its shape can be seen as a wedge surrounded and attached by strong ligaments, allowing it to have a small range of motion [28]. More recently, Haapamaki et al. This study shows the limited ability of radiographs in diagnosing Lisfranc injury. government site. Am J Sports Med 30 (6):871-878, 2002, with permission.) Nunley JA, Vertullo CJ. With the advent and development of magnetic resonance imaging (MRI) auxiliary diagnosis technology, many scholars have conducted imaging studies on Lisfranc joint injuries using MRI. Conventional radiographs miss a significant number of cases of Lisfranc injury. CONCLUSION. Subtleties of Lisfranc fracture-dislocations. We thank Jacqueline Rowbottom for performing the phantom radiographs. 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. 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%. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. Fig. This is a relatively common, and sometimes career-ending injury in the NFL. Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. Imaging for Lisfranc Joint Injury. 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. An estimated 20% of all Lisfranc injuries are Castro M, Melao L, Canella C, Weber M, Negrao P, Trudell D, et al. Leenen LP, van der Werken C. Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study. Certain types of Lisfranc injuries require surgery. 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. Osteopoikilosis 38. 2009;28(3):3517. During walking, the midfoot transfers the forces generated by the calf muscles to the front of the foot. 1998;19(8):53741. 2009;38(3):25560. 2010;195(6):W44755. Delay in diagnosis is known to be associated with a poor outcome [10]. Our results would suggest that a false-negative radiograph is unlikely to require surgical fixation. He also reviews both non-surgical and surgical considerations when dealing with Lisfranc injuries. . A doctor will be able to evaluate the x-rays and imaging tests to determine the extent of the injury. 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 . 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. The .gov means its official. The foot was placed in the knee coil, and sandbags were placed around the foot for fixation. Lisfranc injury: imaging findings for this important but often-missed diagnosis. Federal government websites often end in .gov or .mil. 2007;38(7):85660. 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 This injury is repaired surgically with screws, pins and occasionally surgical plates. J Bone Joint Surg Am. RESULTS. 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. 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. The Lisfranc joint is an important part of the transverse arch and longitudinal arch of the foot [1]. Foot Ankle Int. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. 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%. Lundberg A, Goldie I, Kalin B, Selvik G. Kinematics of the ankle/foot camplex: plantarflexion and dorsiflexion. Femoroacetabular Impingement: Radiographic DiagnosisWhat the Radiologist Should Know, Review. Indeed, only 44.4% of the CT-positive cases went on to surgery. 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 Epub 2016 Jun 23. 2018;319(4):38896. 2017;45(8):19018. Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. 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. Tenderness over the midfoot and reproduction of pain with passive motion of the forefoot are suggestive of a Lisfranc injury. 2012;94(14):132537. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. Coss HS, Manos RE, Buoncristiani A, Mills WJ. 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