The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations

Kitsukawa, Kaoru; Hirano, Takaaki; Niki, Hisateru; Tachizawa, Natsuki; Mimura, Hidefumi

doi:10.1177/24730114211069080

Cited by 11 publications

(8 citation statements)

References 38 publications

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“…Kitsukawa et al reported that diagnoses of Lisfranc injury on MRI in oblique plane parallel to the ligament with isotropic 3D MRI reliably matched with direct intraoperative observations. 9 However, MRO is not a dynamic and weight-bearing imaging modality to show functional instability. Another study by Naguib et al, concluded that the accuracy of surgeons’ eye tracking assessment of intraoperative fluoroscopic imaging during stress examination of the tarsometatarsal joint complex in the diagnosis of Lisfranc injuries was reliable.…”

Section: Discussionmentioning

confidence: 99%

“…Despite various imaging methods, intraoperative examination is the gold standard for confirmation of the diagnosis. 9,10 However, the intraoperative stress examination of the Lisfranc joint by applying a distraction force is not standardized and not a reproducible method. 11 Surgeons apply various amounts of force on the joint to confirm the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Listract test: a Standardized Assessment Method for Isolated Lisfranc Instability in Cadaver Models

Mathur

Osei-Hwedieh

Sayyed-Hosseinian

et al. 2023

Preprint

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Background: The gold standard for diagnosis of Lisfranc instability is direct visualization in the operation room while the examination techniques is still unstandardized and non-reproducible. We aimed to introduce a novel reproducible intraoperative mechanical testing method (Listract test) for intraoperative isolated Lisfranc instability assessment. Methods: The Lisfranc ligament between the first cuneiform (C1) and second metatarsus (M2) in eight lower leg cadaveric specimens were dissected to replicate C1-M2 Lisfranc instability by eight foot and ankle surgeons. The 50N distraction force was applied in the direction of the C1-M2 ligament. Three methods of fixation - flexible fixation, metal screw, and bio-absorbable screw- were used to fix the injury, and Listract test was applied again after fixation. Besides intraoperative assessment, C1-M2 diastasis and area were measured using radiographs for assessment of Lisfranc instability. Results: The sensitivity and specificity of the Listract test for detection of C1-M2 instability were 100% and 100% intraoperatively, 33.3% and 95.2% using radiographic diastasis measurement, and 63.2% and 38% using area measurement, respectively. The Listract test had a specificity and sensitivity of 100% and 96% for intraoperative assessment, 87.5% and 64.3 for radiographic C1-M2 diastasis, and 48% and 50% for radiographic area. Conclusion: The Listract test is a simple, reproducible, and replicable intraoperative method for evaluating the Lisfranc joint for instability. Developing a device with this mechanism can help clinicians confirm the diagnosis and provide appropriate treatment particularly for equivocal diagnoses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Listract test: a Standardized Assessment Method for Isolated Lisfranc Instability in Cadaver Models

Mathur

Osei-Hwedieh

Sayyed-Hosseinian

et al. 2023

Preprint

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“…Diagnosis of Lisfranc injuries can be difficult as conventional radiographs of the foot will not show ligament subluxation nor subtle injuries, and as a result, treatment may be delayed, and the patient may suffer from prolonged pain, post-traumatic arthritis, and flat foot [ 6 - 8 ]. The sensitivity of conventional radiographs is only 84% [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…CT and MRI are some of the modalities that are used to assess TMTJ, which are superior to radiographs. CT scans can show uninterrupted images, and MRI is the gold standard modality as it visualizes soft tissues and ligamentous injuries [ 6 , 9 ]. It is documented that MRI has a sensitivity of 90% compared to intraoperative findings [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Lisfranc Injury in a Young Female: A Case Report

ALJohani¹,

Alfadhil²,

Ismael³

et al. 2022

Cureus

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Lisfranc injuries are relatively rare, accounting for only 0.2% of all injuries. It is even rarer to have this injury bilaterally, and not many case reports have been published on this topic. In this report, we present a case of a bilateral Lisfranc injury in a healthy 17-year-old woman that fell from a flight of stairs landing on both feet. The diagnosis was made by weight-bearing x-rays and computed tomography. Weight-bearing x-rays showed a subtle Lisfranc injury in the right foot with widening between the first and second rays and a disruption involving the overlapping bases of the lesser metatarsals as well as a left comminuted fracture of the proximal third and fourth metatarsals (MT) with intra-articular extension at the proximal fourth MT. CT scan of the right foot showed a fracture of the lateral margin of the medial cuneiform with a displaced bony fragment as well as a comminuted fracture of the third and fourth metatarsals with intra-articular extension and no dislocation. Surgical management, in the form of open reduction and internal fixation, was undertaken for both feet in the same setting. She had an expected course postoperatively and has been doing well, with no pain nor limitation in her activity at her six-month postoperative visit. Moreover, we present a brief review of similar published cases and an overview of Lisfranc injuries.

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“…4). If previous investigations have been normal and there is continuing concern regarding the injury, MRI is superior in revealing the so-called subtle injury 28,35,37,38 . Stress testing under anesthesia has been performed historically, but with advances in imaging, is now seldom used for diagnostic purposes, although commonly performed at the time of operative stabilization.…”

Section: Investigationsmentioning

confidence: 99%

Management of Lisfranc Injuries

et al. 2023

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There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations.Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury.Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries.Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area.We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.

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The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations

Cited by 11 publications

References 38 publications

Listract test: a Standardized Assessment Method for Isolated Lisfranc Instability in Cadaver Models

Listract test: a Standardized Assessment Method for Isolated Lisfranc Instability in Cadaver Models

Bilateral Lisfranc Injury in a Young Female: A Case Report

Management of Lisfranc Injuries

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