Prediction of Midfoot Instability in the Subtle Lisfranc Injury

Raikin, Steven M.; Elias, Ilan; Dheer, Sachin; Besser, Marcus P.; Morrison, William B.; Zoga, Adam C.

doi:10.2106/jbjs.h.01075

Cited by 158 publications

(31 citation statements)

References 17 publications

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“…Longitudinal instability required sectioning of both the interosseous first cuneiform, second metatarsal ligament and the interosseous ligament between the first and second cuneiforms. Raikin et al[ 21 ] pointed out in research on the Lisfranc injuries of American football players that rupture or grade-2 sprain of pC1-M2M3 is highly suggestive of an unstable midfoot, for which surgical stabilization is recommended. The appearance of a normal ligament is suggestive of a stable midfoot and the documentation of its integrity may obviate the need for a manual stress radiographic evaluation under anesthesia for a patient with equivocal clinical and radiographic examinations.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

Jia

et al. 2020

WJCC

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BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past, and there is little related research on the diagnosis and treatment of these injuries. In recent years with the rise in foot and ankle surgery, doctors are now paying more attention to this type of injury. However, there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments, which eventually result in greater sequelae; including long-term pain, arthritis, foot deformity etc . In particular, for cases with a mild Lisfranc joint complex injury, the incidence of sequelae is higher. AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment. METHODS The clinical data of 18 patients, including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed. All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires. X-ray images were taken and follow-up was performed monthly after the operation; the internal fixation was then removed 4-5 mo after the operation; and the American Orthopedic Foot and Ankle Society (AOFAS) score was used for evaluation on the last follow-up. RESULTS All patients were followed up for 6-12 mo. A good/excellent AOFAS score was observed in 88.9% of patients. CONCLUSION For atypical Lisfranc joint complex injuries, active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

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Section: Discussionmentioning

confidence: 99%

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

Jia

et al. 2020

WJCC

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“…The most significant limitation to determining the diagnostic accuracy of any imaging modality is the lack of a non‐invasive gold‐standard diagnostic test from which to calculate specificity and sensitivity. Surgical findings of disruption or instability are often used as a reference standard for diagnosis . Considering that a significant proportion of LF injuries are treated non‐operatively it is not possible to determine the accuracy of this diagnosis in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical findings of disruption or instability are often used as a reference standard for diagnosis. 7,12,13 Considering that a significant proportion of LF injuries are treated non-operatively it is not possible to determine the accuracy of this diagnosis in these patients.…”

Section: Limitationsmentioning

confidence: 99%

Utility of weight‐bearing radiographs compared to computed tomography scan for the diagnosis of subtle Lisfranc injuries in the emergency setting

Kennelly

Klaassen

Heitman

et al. 2019

Emerg Medicine Australasia

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Objective The goal of the present study was to compare the diagnostic yield of weight‐bearing radiographs with non‐weight‐bearing computed tomography (CT) scan for subtle Lisfranc (LF) injuries in the ED. Methods Retrospective analysis of patients presenting with a suspected LF injury over a 2 year period from 2016 to 2017 who had both weight‐bearing bilateral foot radiographs and CT scan. Information extracted included patient demographics, radiographic findings of metatarsal fractures, fleck sign and measurements of diastasis between the medial cuneiform and second metatarsal expressed as a ratio of the uninjured side, clinical findings and treatment modality. Radiologist reports were recorded as either positive, negative or equivocal for a LF injury. Results A total of 117 patients were included with a mean age of 38 years and 54% (n = 63) women. When initial weight‐bearing radiographs were positive, 54% of subsequent CT scans were reported as either equivocal or negative. Of the patients who had a negative or equivocal weight‐bearing radiograph, only 12% had a positive CT scan. The mean diastasis ratio in patients undergoing surgery was 1.53 (95% confidence interval 1.41–1.65) compared to 1.11 (95% confidence interval 1.07–1.16) for patients with injuries not requiring operative intervention (P < 0.001). There was a statistically significant correlation between a positive weight‐bearing radiograph and surgical treatment (R = 0.339, P < 0.001), and between diastasis measurements and surgical treatment (R = 0.576, P < 0.001). Conclusions CT provides limited benefit in the diagnosis and initial management of suspected subtle LF injuries in the ED. We advocate for the use of bilateral weight‐bearing radiographs as a first‐line investigation.

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“…Potter et al 27 established the utility of MRI for the assessment of Lisfranc injury in a series of athletes who had sustained acute midfoot injuries, demonstrating high accuracy upon radiographic and surgical correlation and confirming prior reports that the weaker dorsal fibers of the ligament are more commonly torn than the more robust plantar fibers in the setting of partial thickness injury (Figure 4B and 4C). 24 Raikin et al 29 demonstrated that disruption of the plantar fibers of the Lisfranc ligament on imaging provides a predictor of Lisfranc joint instability, with a positive predictive value of 94%, allowing accurate determination of the need for surgical intervention.…”

Section: Pathologymentioning

confidence: 99%

“…1,6,29 Such injuries account for approximately 2% to 18% of athletic injuries, depending on the type of activity, with sports involving running, jumping, and contact resulting in greater risk of injury. Foot injuries constitute approximately 2% of football, basketball, and women’s soccer injuries; 4% of men’s soccer injuries; and up to 18% of martial arts injuries.…”

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confidence: 99%

Imaging of Sports-Related Midfoot and Forefoot Injuries

2012

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Sports-related injuries of the foot are common and may result in significant morbidity, particularly if inaccurate or delayed diagnosis leads to improper management. While less common than injuries of the ankle, sports-related foot injuries account for 2% to 18% of athletic injuries. Injury may occur as a result of acute trauma or chronic overuse, and high-impact sports that involve running, jumping, or contact place the athlete at higher risk for injury. Accurate and timely diagnosis of injury is the key to proper management, and diagnostic imaging studies often play a critical role in this regard. While radiographs, computerized tomography scans, and ultrasound are useful in the evaluation of the foot, magnetic resonance imaging provides superior tissue contrast as well as the ability to detect stress reaction in bone that precedes discernible fracture line on radiographs, allowing accurate detection of both osseous and soft tissue pathology. This review focuses on imaging of common sports-related injuries of the midfoot and forefoot, including osseous, ligamentous, and tendinous pathology, with emphasis on magnetic resonance imaging diagnosis.

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Prediction of Midfoot Instability in the Subtle Lisfranc Injury

Cited by 158 publications

References 17 publications

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

Utility of weight‐bearing radiographs compared to computed tomography scan for the diagnosis of subtle Lisfranc injuries in the emergency setting

Imaging of Sports-Related Midfoot and Forefoot Injuries

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