Weightbearing CT Reveals No Anatomical Features Associated With Ligamentous Lisfranc Injuries: A Matched Case-Control...

Area of Science:

• Orthopedic surgery
• Radiology
• Biomechanics

Background:

• Previous studies suggested anatomical variations in the Lisfranc joint complex may predispose individuals to ligamentous injuries.
• These associations were primarily based on 2D imaging or post-injury assessments.
• Weightbearing computed tomography (WBCT) offers 3D evaluation under physiologic load for a more accurate assessment.

Purpose of the Study:

• To reassess proposed anatomical associations with ligamentous Lisfranc injuries using WBCT.
• To compare WBCT scans of injured feet with uninjured controls to identify specific anatomical features.

Main Methods:

• Retrospective matched case-control study of 34 patients with Lisfranc injuries and 34 controls.
• WBCT scans of uninjured contralateral feet were analyzed.
• Measurements included second metatarsal (M2) length, mortise depths, foot length, and alignment parameters.

Main Results:

• No significant differences were found in M2 length, medial/lateral mortise depths, or foot alignment parameters between groups.
• A nominal difference in the sagittal first tarsometatarsal angle did not persist after correction.
• High intraobserver and moderate-to-excellent interobserver reliability were noted for measurements.

Conclusions:

• WBCT did not reveal consistent anatomical associations between Lisfranc injuries and specific features of the second metatarsal, mortise morphology, or foot alignment.
• These results challenge prior hypotheses regarding anatomical predispositions to Lisfranc injuries.
• Standardized, weightbearing 3D imaging is valuable for midfoot anatomy evaluation.