MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament
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The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury.
Materials and methods
Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases.
Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures.
MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low.
KeywordsLisfranc joint Lisfranc ligament Injuries Magnetic resonance imaging
- 4.Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. The Am J Sports Med. 2002; 30(6): 871–878.Google Scholar
- 7.Hunt SA, Ropiak C, Tejwani NC. Lisfranc joint injuries: diagnosis and treatment. Am J Orthop. (Belle Mead, NJ. 2006; 35(8): 376–385.Google Scholar
- 9.Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int/American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1998; 19(7): 438–446.Google Scholar
- 12.Lee CA, Birkedal JP, Dickerson EA, Vieta PA Jr., Webb LX, Teasdall RD. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int/American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2004; 25(5): 365–370.Google Scholar