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Lisfranc joint displacement following sequential ligament sectioning
Scott Kaar1, John Femino, Yoav Morag
1Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Taubman Center 2914, Ann Arbor, MI 48109-0328, USA. skaar@med.umich.edu
The Journal of Bone and Joint Surgery. American Volume
|October 3, 2007
Summary
Stress radiographs are more effective than weight-bearing images for diagnosing Lisfranc (first cuneiform-second metatarsal) joint instability. Specific stress views better identify transverse and longitudinal Lisfranc injury patterns.
Area of Science:
- Orthopedics
- Radiology
- Biomechanics
Background:
- Lisfranc (first cuneiform-second metatarsal) joint injuries present with two main radiographic patterns: transverse and longitudinal.
- Current diagnostic methods lack consistent accuracy for identifying unstable Lisfranc injuries.
Purpose of the Study:
- To determine which specific ligament disruptions correlate with transverse and longitudinal Lisfranc instability patterns.
- To compare the diagnostic utility of weight-bearing versus injury-specific stress radiographs for detecting these instability patterns.
Main Methods:
- Cadaveric lower extremities were dissected to expose the midfoot.
- Radiographic markers were placed on key tarsal and metatarsal bones.
- Ligaments were sequentially sectioned to simulate transverse and longitudinal Lisfranc injuries.
- Weight-bearing, adduction stress, and abduction stress radiographs were obtained before and after ligament sectioning.
- Instability was defined as >= 2 mm of displacement on digitized radiographs.
Main Results:
- Abduction stress radiographs were highly effective (5/5 specimens) in diagnosing transverse Lisfranc instability.
- Adduction stress radiographs were effective (4/5 specimens) in diagnosing longitudinal Lisfranc instability.
- Weight-bearing radiographs showed limited diagnostic capability for both instability patterns.
Conclusions:
- Transverse Lisfranc instability results from combined disruption of the interosseous first cuneiform-second metatarsal ligament and the plantarLisfranc ligament.
- Longitudinal Lisfranc instability results from combined disruption of the interosseous first cuneiform-second metatarsal ligament and the intercuneiform ligament.
- Injury-specific stress radiographs provide superior visualization of displacement compared to weight-bearing radiographs for evaluating Lisfranc instability.