Imaging in Lisfranc injury

TY - JOUR

T1 - Imaging in Lisfranc injury

T2 - a systematic literature review

AU - Sripanich, Yantarat

AU - Weinberg, Maxwell W

AU - Krähenbühl, Nicola

AU - Rungprai, Chamnanni

AU - Mills, Megan K

AU - Saltzman, Charles L

AU - Barg, Alexej

PY - 2020/1

Y1 - 2020/1

N2 - OBJECTIVES: To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.MATERIALS AND METHODS: PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool.RESULTS: Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice.CONCLUSIONS: While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.

AB - OBJECTIVES: To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.MATERIALS AND METHODS: PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool.RESULTS: Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice.CONCLUSIONS: While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.

KW - Foot Injuries/diagnostic imaging

KW - Foot Joints/diagnostic imaging

KW - Humans

KW - Ligaments, Articular/diagnostic imaging

KW - Magnetic Resonance Imaging

KW - Radiography

KW - Tomography, X-Ray Computed

KW - Ultrasonography

KW - Weight-Bearing

U2 - 10.1007/s00256-019-03282-1

DO - 10.1007/s00256-019-03282-1

M3 - SCORING: Journal article

C2 - 31368007

VL - 49

SP - 31

EP - 53

JO - SKELETAL RADIOL

JF - SKELETAL RADIOL

SN - 0364-2348

IS - 1

ER -