Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes

Abstract

Background: We report data on the largest cohort to date of patients who sustained a ligamentous Lisfranc injury during sport. To date, the prevalence of concurrent intercuneiform ligament injuries in the competitive athlete with subtle Lisfranc instability has not been reported. Methods: Eighty-two patients (64 males, 18 females) sustained an unstable Lisfranc injury (49 left, 33 right) and met inclusion criteria. Injuries were classified as traditional dislocation (TRAD, first to second TMT ligament tear), medial column dislocation (MCD, second TMT, and medial-middle cuneiform ligament tear), or proximal extension dislocation (PE, first, second, and medial-middle cuneiform ligament tear) and the injury pattern confirmed at surgery. All athletes underwent open reduction with internal fixation (ORIF) of each unstable midfoot segment. Fisher exact tests and 2-tailed t tests were used to analyze statistical significance according to injury pattern, sport, gender difference, hindfoot angle alignment, and injured side ( P < .05). Results: Average age of athletes was 21.0 ± 5.3 years old (range 12-40), and return to sports was 7.5 ± 2.1 months. Injury distribution was as follows: TRAD (n = 40), MCD (n = 17), and PE (n = 23). MCD trended toward a longer return to sport (8.4 ± 3.3 months, P = .074). Football was the most common sport at time of injury (n = 48). Wakeboard athletes (n = 5) were older (31.4 ± 3.2, P = .0002), and MCD tears were more prevalent among them ( P = .061). Basketball (n = 13) players were significantly younger (19.1 ± 2.5 years, P = .028) and returned to sports quicker (5.2 ± 0.7, P = .0002). Return to sport data indicated a typical population for athletes with Lisfranc injury in these sports. Conclusion: Proximal extension disruption (intercuneiform ligament tear) occurred in 50% of these low-energy Lisfranc athletic injuries. MCD and PE may be more prevalent than previously understood. This is the first study to document the extent, pattern, and prevalence of associated intercuneiform ligament tears in the competitive athlete with a low-energy subtle, unstable Lisfranc injury. Level of Evidence: Level IV, retrospective case series.

Suture Button vs Conventional Screw Fixation for Isolated Lisfranc Ligament Injuries

“…3,8 Nevertheless, because of the biomechanical importance of the Lisfranc joint as a keystone in the foot arch, even a subtle injury should be classified precisely, followed by adequate management. 14,27,28…”

Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries

“…Indeed, multiple classifications have been presented, yet there is still no consensus on the precise definition of Lisfranc injuries [6,25,33]. Nevertheless, Lisfranc injury is recognized nowadays as a wide variety of both bony and ligamentous injuries of the TMT joint region ranging from subtle ligamentous injuries to severely displaced or crush injuries [21,25,33,35,43,45].…”

“…It has also been reported that the sensitivity of the weightbearing radiograph is not higher compared with the non-weight-bearing radiograph and is less sensitive than CT [ 38 ]. Nevertheless, many of the previously published studies have still relied on non-weight-bearing or weight-bearing radiographs [ 8 , 9 , 12 , 20 , 23 , 29 , 33 , 35 , 41 , 47 ].…”

Using area and volume measurement via weightbearing CT to detect Lisfranc instability

“…8,9 Furthermore, the intercuneiform joint (C1-C2) was deemed unstable if the dorsal intercuneiform ligament was ruptured with any diastasis or subluxation. 8,10 These patients received surgical fixation of the Lisfranc joint complex as part of their clinical course.…”