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Imaging in Lisfranc injury: a systematic literature review

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A Correction to this article was published on 27 December 2019

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Abstract

Objectives

To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.

Materials and methods

PubMed and ScienceDirect were systematically searched. 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). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool.

Results

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. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice.

Conclusions

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. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. 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. Overall, the available studies’ methodological quality was satisfactory.

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Change history

  • 27 December 2019

    Unfortunately in Volume 49, Issue 1 had been published online with an incorrect date (2001 instead of 2020).

References

  1. Cassebaum WH. Lisfranc fracture-dislocations. Clin Orthop Relat Res. 1963;30:116–29.

    CAS  PubMed  Google Scholar 

  2. Solan MC, Moorman CT 3rd, Miyamoto RG, Jasper LE, Belkoff SM. Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int. 2001;22(8):637–41.

    CAS  PubMed  Google Scholar 

  3. DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. Foot Ankle Clin. 2009;14(2):169–86.

    PubMed  Google Scholar 

  4. Myerson MS, Cerrato R. Current management of tarsometatarsal injuries in the athlete. Instr Course Lect. 2009;58:583–94.

    PubMed  Google Scholar 

  5. McHale KJ, Vopat BG, Beaulieu-Jones BR, Sanchez G, Whalen JM, McDonald LS, et al. Epidemiology and outcomes of Lisfranc injuries identified at the National Football League Scouting Combine. Am J Sports Med. 2017;45(8):1901–8.

    PubMed  Google Scholar 

  6. Porter DA, Barnes AF, Rund A, Walrod MT. Injury pattern in ligamentous Lisfranc injuries in competitive athletes. Foot Ankle Int. 2018;40(2):185–94.

    Google Scholar 

  7. Norfray JF, Geline RA, Steinberg RI, Galinski AW, Gilula LA. Subtleties of Lisfranc fracture-dislocations. AJR Am J Roentgenol. 1981;137(6):1151–6.

    CAS  PubMed  Google Scholar 

  8. Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? And how can we improve? Injury. 2007;38(7):856–60.

    PubMed  Google Scholar 

  9. Wei CJ, Tsai WC, Tiu CM, Wu HT, Chiou HJ, Chang CY. Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol. 2006;47(7):710–7.

    PubMed  Google Scholar 

  10. Groulier P, Pinaud JC. Tarso-metatarsal dislocations (10 cases). Rev Chir Orthop Reparatrice Appar Mot. 1970;56(4):303–24.

    CAS  PubMed  Google Scholar 

  11. Philbin T, Rosenberg G, Sferra JJ. Complications of missed or untreated Lisfranc injuries. Foot Ankle Clin. 2003;8(1):61–71.

    PubMed  Google Scholar 

  12. Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC. Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Joint Surg Am. 2009;91(4):892–9.

    PubMed  Google Scholar 

  13. Foster SC, Foster RR. Lisfranc's tarsometatarsal fracture-dislocation. Radiology. 1976;120(1):79–83.

    CAS  PubMed  Google Scholar 

  14. Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am. 1990;72(10):1519–22.

    CAS  PubMed  Google Scholar 

  15. Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 2002;30(6):871–8.

    PubMed  Google Scholar 

  16. Seo DK, Lee HS, Lee KW, Lee SK, Kim SB. Nonweightbearing radiographs in patients with a subtle Lisfranc injury. Foot Ankle Int. 2017;38(10):1120–5.

    PubMed  Google Scholar 

  17. Woodward S, Jacobson JA, Femino JE, Morag Y, Fessell DP, Dong Q. Sonographic evaluation of Lisfranc ligament injuries. J Ultrasound Med. 2009;28(3):351–7.

    PubMed  Google Scholar 

  18. Graves NC, Rettedal DD, Marshall JJ, Frush K, Vardaxis V. Ultrasound assessment of dorsal Lisfranc ligament strain under clinically relevant loads. J Am Podiatr Med Assoc. 2014;104(1):11–8.

    PubMed  Google Scholar 

  19. Marshall JJ, Graves NC, Rettedal DD, Frush K, Vardaxis V. Ultrasound assessment of bilateral symmetry in dorsal Lisfranc ligament. J Foot Ankle Surg. 2013;52(3):319–23.

    PubMed  Google Scholar 

  20. Rettedal DD, Graves NC, Marshall JJ, Frush K, Vardaxis V. Reliability of ultrasound imaging in the assessment of the dorsal Lisfranc ligament. J Foot Ankle Res. 2013;6(1):7.

    PubMed  PubMed Central  Google Scholar 

  21. Ryba D, Ibrahim N, Choi J, Vardaxis V. Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging. Foot (Edinb). 2016;26:30–5.

    Google Scholar 

  22. Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA. Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. Foot Ankle Int. 1997;18(6):351–5.

    CAS  PubMed  Google Scholar 

  23. Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int. 2004;25(9):614–9.

    PubMed  Google Scholar 

  24. Rankine JJ, Nicholas CM, Wells G, Barron DA. The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR Am J Roentgenol. 2012;198(4):W365–9.

    PubMed  Google Scholar 

  25. Preidler KW, Brossmann J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. AJR Am J Roentgenol. 1996;167(5):1217–22.

    CAS  PubMed  Google Scholar 

  26. Preidler KW, Wang YC, Brossmann J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MR images. Radiology. 1996;199(3):733–6.

    CAS  PubMed  Google Scholar 

  27. Delfaut EM, Rosenberg ZS, Demondion X. Malalignment at the Lisfranc joint: MR features in asymptomatic patients and cadaveric specimens. Skelet Radiol. 2002;31(9):499–504.

    Google Scholar 

  28. Macmahon PJ, Dheer S, Raikin SM, Elias I, Morrison WB, Kavanagh EC, et al. MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament. Skelet Radiol. 2009;38(3):255–60.

    CAS  Google Scholar 

  29. Castro M, Melao L, Canella C, Weber M, Negrao P, Trudell D, et al. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol. 2010;195(6):W447–55.

    PubMed  Google Scholar 

  30. Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 2014;34(2):514–31.

    PubMed  Google Scholar 

  31. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.

    Google Scholar 

  32. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388–96.

    PubMed  Google Scholar 

  33. Yu-Kai Y, Shiu-Bii L. Anatomic parameters of the Lisfranc joint complex in a radiographic and cadaveric comparison. J Foot Ankle Surg. 2015;54(5):883–7.

    PubMed  Google Scholar 

  34. 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. Foot Ankle Int. 2015;36(12):1483–92.

    PubMed  Google Scholar 

  35. Coss HS, Manos RE, Buoncristiani A, Mills WJ. Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. Foot Ankle Int. 1998;19(8):537–41.

    CAS  PubMed  Google Scholar 

  36. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int. 1998;19(7):438–46.

    CAS  PubMed  Google Scholar 

  37. Shapiro MS, Wascher DC, Finerman GA. Rupture of Lisfranc’s ligament in athletes. Am J Sports Med. 1994;22(5):687–91.

    CAS  PubMed  Google Scholar 

  38. Knijnenberg LM, Dingemans SA, Terra MP, Struijs PAA, Schep NWL, Schepers T. Radiographic anatomy of the pediatric Lisfranc joint. J Pediatr Orthop. 2018;38(10):510–3.

    PubMed  Google Scholar 

  39. Kaicker J, Zajac M, Shergill R, Choudur HN. Ultrasound appearance of the normal Lisfranc ligament. Emerg Radiol. 2016;23(6):609–14.

    PubMed  Google Scholar 

  40. Preidler KW, Peicha G, Lajtai G, Seibert FJ, Fock C, Szolar DM, et al. Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. AJR Am J Roentgenol. 1999;173(6):1673–7.

    CAS  PubMed  Google Scholar 

  41. 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. Skelet Radiol. 2013;42(3):399–409.

    Google Scholar 

  42. Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg. 2010;18(12):718–28.

    PubMed  Google Scholar 

  43. Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc and Chopart injuries. J Bone Joint Surg Am. 2012;94(14):1325–37.

    PubMed  Google Scholar 

  44. Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, et al. ACR appropriateness criteria acute trauma to the foot. J Am Coll Radiol. 2015;12(6):575–81.

    PubMed  Google Scholar 

  45. Goiney RC, Connell DG, Nichols DM. CT evaluation of tarsometatarsal fracture-dislocation injuries. AJR Am J Roentgenol. 1985;144(5):985–90.

    CAS  PubMed  Google Scholar 

  46. Kalia V, Fishman EK, Carrino JA, Fayad LM. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skelet Radiol. 2012;41(2):129–36.

    Google Scholar 

  47. Chan BY, Markhardt BK, Williams KL, Kanarek AA, Ross AB. Os conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. AJR Am J Roentgenol. 2019:1–10.

  48. Weatherford BM, Anderson JG, Bohay DR. Management of tarsometatarsal joint injuries. J Am Acad Orthop Surg. 2017;25(7):469–79.

    PubMed  Google Scholar 

  49. Barg A, Bailey T, Richter M, de Cesar Netto C, Lintz F, Burssens A, et al. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int. 2018;39(3):376–86.

    PubMed  Google Scholar 

  50. Haidich AB. Meta-analysis in medical research. Hippokratia. 2010;14(Suppl 1):29–37.

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Yantarat Sripanich, Maxwell W. Weinberg, Nicola Krähenbühl, Charles L. Saltzman & Alexej Barg

  2. Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand

    Chamnanni Rungprai

  3. Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT, 84132, USA

    Megan K. Mills

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  1. Yantarat Sripanich
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Sripanich, Y., Weinberg, M.W., Krähenbühl, N. et al. Imaging in Lisfranc injury: a systematic literature review. Skeletal Radiol 49, 31–53 (2020). https://doi.org/10.1007/s00256-019-03282-1

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