Skip to main content
SpringerLink
Log in

Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Subtle Lisfranc joint injuries remain challenging to diagnose in clinical practice. Although of questionable accuracy, bilateral weightbearing radiographs are considered the current gold standard to assess these injuries. However, weightbearing computed tomography (WBCT), which provides clearer visualization of bony landmarks, can also be used for evaluation. This study aims to design a protocol that reliably measures the distance between the medial cuneiform (C1) and second metatarsal (M2) to assess the Lisfranc joint using WBCT imaging.

Methods

Two unique methods of measuring the C1–M2 distance were designed that localize the center of the interosseous Lisfranc ligament (ILL, reference point). This reference point was located by (I) measuring a specific distance at the M2 base, or (II) approximating from nearby bony landmarks, on both axial (Ax) and coronal (Cor) WBCT images. Four parameters (I-Ax, I-Cor, II-Ax, and II-Cor) were evaluated for each of 96 specimens. Measurements were recorded by three independent observers and repeated for inter- and intra-observer agreement.

Results

In total, 96 patient image series were included and assessed in our study with an average age of 46 (19–66, SD 16.1) and average BMI of 25.8 (17.8–30.5, SD 4.3). I-Ax showed excellent agreement for intra-observer evaluation (R = 0.802) and good agreement for inter-observer evaluation (R = 0.727). I-Cor demonstrated excellent inter- (R = 0.814) and intra-observer (R = 0.840) agreement. Good agreement was found for both II-Ax and II-Cor for both intra- (R = 0.730, R = 0.708) and inter-observer (R = 0.705, R = 0.645) evaluation.

Conclusion

Measuring the C1–M2 joint space with coronal WBCT imaging through a protocol that localizes the ILL is reproducible, simple, and can potentially be utilized clinically to evaluate the Lisfranc joint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aronow MS (2006) Treatment of the missed Lisfranc injury. Foot Ankle Clin 11(1):127–142

    Article  Google Scholar 

  2. Cassebaum WH (1963) Lisfranc fracture-dislocations. Clin Orthop Relat Res 30:116–129

    Article  CAS  Google Scholar 

  3. Castro M, Melao L, Canella C et al (2010) Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol 195(6):W447–455

    Article  Google Scholar 

  4. Chan BY, Markhardt BK, Williams KL, Kanarek AA, Ross AB (2019) Os Conundrum: identifying symptomatic sesamoids and accessory ossicles of the foot. AJR Am J Roentgenol 213:1–10

    Article  Google Scholar 

  5. Coss HS, Manos RE, Buoncristiani A, Mills WJ (1998) Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. Foot Ankle Int 19(8):537–541

    Article  CAS  Google Scholar 

  6. de Palma L, Santucci A, Sabetta SP, Rapali S (1997) Anatomy of the Lisfranc joint complex. Foot Ankle Int 18(6):356–364

    Article  Google Scholar 

  7. Faciszewski T, Burks RT, Manaster BJ (1990) Subtle injuries of the Lisfranc joint. J Bone Joint Surg Am 72(10):1519–1522

    Article  CAS  Google Scholar 

  8. Foster SC, Foster RR (1976) Lisfranc’s tarsometatarsal fracture-dislocation. Radiology 120(1):79–83

    Article  CAS  Google Scholar 

  9. Groulier P, Pinaud JC (1970) Tarso-metatarsal dislocations (10 cases). Rev Chir Orthop Reparatrice Appar Mot 56(4):303–324

    CAS  PubMed  Google Scholar 

  10. Haapamaki V, Kiuru M, Koskinen S (2004) Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int 25(9):614–619

    Article  Google Scholar 

  11. Haapamaki VV, Kiuru MJ, Koskinen SK (2004) Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol 183(3):615–622

    Article  Google Scholar 

  12. Hirano T, Niki H, Beppu M (2013) Anatomical considerations for reconstruction of the Lisfranc ligament. J Orthop Sci 18(5):720–726

    Article  Google Scholar 

  13. Kalia V, Fishman EK, Carrino JA, Fayad LM (2012) Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol 41(2):129–136

    Article  Google Scholar 

  14. Kitsukawa K, Hirano T, Niki H, Tachizawa N, Nakajima Y, Hirata K (2015) MR Imaging evaluation of the Lisfranc ligament in cadaveric feet and patients with acute to chronic Lisfranc injury. Foot Ankle Int 36(12):1483–1492

    Article  Google Scholar 

  15. Knijnenberg LM, Dingemans SA, Terra MP, Struijs PAA, Schep NWL, Schepers T (2018) Radiographic anatomy of the pediatric Lisfranc Joint. J Pediatr Orthop 38(10):510–513

    Article  Google Scholar 

  16. Kosters C, Bockholt S, Muller C et al (2014) Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures. Arch Orthop Trauma Surg 134(10):1397–1404

    Article  CAS  Google Scholar 

  17. Kura H, Luo ZP, Kitaoka HB, Smutz WP, An KN (2001) Mechanical behavior of the Lisfranc and dorsal cuneometatarsal ligaments: in vitro biomechanical study. J Orthop Trauma 15(2):107–110

    Article  CAS  Google Scholar 

  18. Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA (1997) Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. Foot Ankle Int 18(6):351–355

    Article  CAS  Google Scholar 

  19. Milankov M, Miljkovic N, Popovic N (2003) Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations. Arch Orthop Trauma Surg 123(2–3):95–97

    Article  Google Scholar 

  20. Miyamoto W, Takao M, Innami K, Miki S, Matsushita T (2015) Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes. Arch Orthop Trauma Surg 135(8):1063–1070

    Article  Google Scholar 

  21. Norfray JF, Geline RA, Steinberg RI, Galinski AW, Gilula LA (1981) Subtleties of Lisfranc fracture-dislocations. AJR Am J Roentgenol 137(6):1151–1156

    Article  CAS  Google Scholar 

  22. Nunley JA, Vertullo CJ (2002) Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med 30(6):871–878

    Article  Google Scholar 

  23. Panchbhavi VK, Dt M, Villarreal J, Curry MC, Andersen CR (2013) Three-dimensional, digital, and gross anatomy of the Lisfranc ligament. Foot Ankle Int 34(6):876–880

    Article  Google Scholar 

  24. Ponkilainen VT, Laine HJ, Maenpaa HM, Mattila VM, Haapasalo HH (2018) Incidence and Characteristics of Midfoot Injuries. Foot Ankle Int. https://doi.org/10.1177/1071100718799741

    Article  PubMed  Google Scholar 

  25. Porter DA, Barnes AF, Rund A, Walrod MT (2018) Injury pattern in ligamentous Lisfranc injuries in competitive athletes. Foot Ankle Int. https://doi.org/10.1177/1071100718802264

    Article  PubMed  Google Scholar 

  26. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF (1998) Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int 19(7):438–446

    Article  CAS  Google Scholar 

  27. Preidler KW, Peicha G, Lajtai G et al (1999) Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. AJR Am J Roentgenol 173(6):1673–1677

    Article  CAS  Google Scholar 

  28. Rankine JJ, Nicholas CM, Wells G, Barron DA (2012) The diagnostic accuracy of radiographs in Lisfranc injury and the potential value of a craniocaudal projection. AJR Am J Roentgenol 198(4):W365–369

    Article  Google Scholar 

  29. Seo DK, Lee HS, Lee KW, Lee SK, Kim SB (2017) Nonweightbearing Radiographs in Patients With a Subtle Lisfranc Injury. Foot Ankle Int 38(10):1120–1125

    Article  Google Scholar 

  30. Shapiro MS, Wascher DC, Finerman GA (1994) Rupture of Lisfranc's ligament in athletes. Am J Sports Med 22(5):687–691

    Article  CAS  Google Scholar 

  31. Sherief TI, Mucci B, Greiss M (2007) Lisfranc injury: how frequently does it get missed? And how can we improve? Injury 38(7):856–860

    Article  Google Scholar 

  32. Siddiqui NA, Galizia MS, Almusa E, Omar IM (2014) Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics 34(2):514–531

    Article  Google Scholar 

  33. Solan MC, Moorman CT 3rd, Miyamoto RG, Jasper LE, Belkoff SM (2001) Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int 22(8):637–641

    Article  CAS  Google Scholar 

  34. Sripanich Y, Weinberg MW, Krahenbuhl N et al (2020) Imaging in Lisfranc injury: a systematic literature review. Skeletal Radiol 49(1):31–53. https://doi.org/10.1007/s00256-019-03282-1

    Article  PubMed  Google Scholar 

  35. Watson TS, Shurnas PS, Denker J (2010) Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg 18(12):718–728

    Article  Google Scholar 

  36. Weatherford BM, Anderson JG, Bohay DR (2017) Management of tarsometatarsal joint injuries. J Am Acad Orthop Surg 25(7):469–479

    Article  Google Scholar 

  37. Wei CJ, Tsai WC, Tiu CM, Wu HT, Chiou HJ, Chang CY (2006) Systematic analysis of missed extremity fractures in emergency radiology. Acta Radiol 47(7):710–717

    Article  Google Scholar 

  38. Yu-Kai Y, Shiu-Bii L (2015) Anatomic parameters of the Lisfranc joint complex in a radiographic and cadaveric comparison. J Foot Ankle Surg 54(5):883–887

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Sebastian Drago Perez and Jesse Steadman for their assistance in measuring applicable study parameters and preparing this manuscript.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Yantarat Sripanich, Maxwell W. Weinberg, Nicola Krähenbühl, Charles L. Saltzman & Alexej Barg

  2. Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand

    Yantarat Sripanich & Chamnanni Rungprai

Authors
  1. Yantarat Sripanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxwell W. Weinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicola Krähenbühl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chamnanni Rungprai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles L. Saltzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexej Barg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexej Barg.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the internal institutional review board of the University of Utah (IRB #00071733).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sripanich, Y., Weinberg, M.W., Krähenbühl, N. et al. Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg 141, 775–781 (2021). https://doi.org/10.1007/s00402-020-03477-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03477-5

Keywords

Search

Navigation