2002;31(9):499504. One of these cases on CT showed an accessory ossicle in the region of the Lisfranc ligament, which had been interpreted as an avulsion on the radiograph. Complications of missed or untreated Lisfranc injuries. A doctor will be able to evaluate the x-rays and imaging tests to determine the extent of the injury. AJR Am J Roentgenol. Conventional radiographs miss a significant number of Lisfranc injuries. Certain types of Lisfranc injuries require surgery. Foot Ankle Clin. Patients present with a severe pain in the midfoot and difficulty in weight-bearing, commonly following road traffic accidents or athletic injuries. An estimated 20% of all Lisfranc injuries are All individual persons consented to publish their data. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. Kitsukawa K, Hirano T, Niki H, Tachizawa N, Nakajima Y, Hirata K. MR imaging evaluation of the Lisfranc ligament in cadaveric feet and patients with acute to chronic Lisfranc injury. Siddiqui NA, Galizia MS, Almusa E, Omar IM. the clinical presentation of lisfranc injuries is as diverse as the possible mechanisms, and a high degree of clinical suspicion is often needed to diagnose subtle injuries. . Hence, the imaging parameters of the Lisfranc ligament were acquired, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries. Deformity correction and arthrodesis of the midfoot with a medial plate. Despite showing injury to the Lisfranc joint, 25 patients did not undergo surgery because the treating surgeon did not consider that the degree of disruption warranted surgical fixation. To arrive at a diagnosis, your doctor will determine how the injury occurred and examine the foot to determine the severity of the injury. Myerson MS. Some articles discussed multiple modalities. 2009;38(3):25560. Osteopoikilosis 38. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury. . Norfray JF, Geline RA, Steinberg RI, Galinski AW, Gilula LA. Would you like email updates of new search results? Although Lisfranc sprains can be difficult to detect at physical ex-amination and imaging, they can be a source of significant morbidity for athletes, with one series reporting that 18% of patients were unable to re-turn to their sport after injury (9). the best planes to delineate their precise configurations are the axial and transverse oblique planes. A Lisfranc joint injury involves a type of injury to the bones and/or ligaments, in the central area of the foot. AA have made substantial contributions to conception and design; DHY contributed to acquisition of data and analysis and interpretation of data; AA have been involved in drafting the manuscript and revising it critically for important intellectual content; LLG have given final approval of the version to be published. Yu-Kai Y, Shiu-Bii L. Anatomic parameters of the Lisfranc joint complex in a radiographic and cadaveric comparison. Lisfranc injuries, as we know, can be difficult to diagnose. The results of the CT determined which patients were examined under anesthesia, and less than half of the patients with a positive CT were taken to the surgery department. The anatomical structure of the Lisfranc joint is complex, and the sensitivity of the X-ray film is only 84.4% [12]. 11 plantar ecchymosis is considered pathognomonic for a lisfranc injury. And how can we improve? In basic terms, it is a sprain of the Lisfranc ligament, also known as the oblique interosseous ligament. The mean ( SD) angle of the joint in the patients was 28.9 5.7. Hui-Yong Ding, Email: moc.361@50gnoyiuh_d. Weatherford BM, Anderson JG, Bohay DR. Management of tarsometatarsal joint injuries. We are experimenting with display styles that make it easier to read articles in PMC. It is generally acknowledged that radiographs can be very subtle in the presence of Lisfranc injury [3, 4]. The bit line should regard the fifth metatarsal base as the reference point. Price excludes VAT (USA)Tax calculation will be finalised during checkout. On the 45 oblique, the first and second metatarsal bases overlap. This injury most commonly occurs via high-impact trauma (such as a car accident or fall) or sports-related situations. Google Scholar. J Am Podiatr Med Assoc. This is an important section for the diagnosis of Lisfranc ligament injuries. Fusion may reduce motion in the foot, but it can be the best course of action in cases where internal fixation is . Depending on the surgeon's preference, wires or screws can be used to bring the bones back to their original position and allow the damaged ligaments to heal. Lisfranc injuries with <2mm of displacement can placed in a bulky dressing for 2-3 days to allow swelling to decrease, a well-padded splint or a well-padded short leg cast placed to accommodate swelling. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. 2017;45(8):19018. The perpendicular to the plantar surface of the foot was determined, and the angle of the second tarsal-metatarsal joint to the perpendicular was recorded (Fig. [4], who tested the performance of nine senior clinicians on a set of 30 radiographs that contained 17 cases of Lisfranc injury and found that only 61% of cases were identified by all the observers. Radiographics. Lapidus PW. 1999;173(6):16737. Rev Chir Orthop Reparatrice Appar Mot. Graves NC, Rettedal DD, Marshall JJ, Frush K, Vardaxis V. Ultrasound assessment of dorsal Lisfranc ligament strain under clinically relevant loads. This is one of the best shoes for Lisfranc injury because it offers a smooth and steady stride. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. OBJECTIVE. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. 1985;144(5):98590. Twenty degrees of angulation was selected as the optimum by consensus opinion. CT scan: If you need surgery your provider or surgeon needs to know exactly how damaged your bones are. Finally, the angle of the joint was measured on the CT examinations of patients with midfoot injury to determine the optimum degree of craniocaudal angulation that would best show the joint on a population of patients being investigated for Lisfranc injury. Rankine JJ, Nicholas CM, Wells G, Barron DA. PubMed J Foot Ankle Surg. The other case showed fractures of the second, third, and fourth metatarsals, which, on CT, were extraarticular with no evidence of involvement of the tarsal-metatarsal joints. Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. The Lisfranc ligament connects the lateral aspect of the medial cuneiform to the medial aspect of the base of the second metatarsal. CT examination of the phantom was obtained. Case Discussion. Kalia V, Fishman EK, Carrino JA, Fayad LM. Lisfranc injuries refer to injuries of the bones, joints, and ligaments of the Lisfranc joint, which are rare in clinical practice; accounting for approximately 0.2% of all fracture cases [9]. Image analysis was performed by three physicians who had a chief physician title. Traumatic disruption of the Lisfranc joint ruptures this ligament, which may be detected on a radiograph as malalignment of the base of the second metatarsal with the intermediate cuneiform and widening between the bases of the first and second metatarsals [1]. 2013;6(1):7. Therefore, we conducted this study to analyze the MRI images of the Lisfranc joint in order to provide an imaging basis for the image recognition and damage diagnosis of this ligament. Plain radiographic findings consistent with Lisfranc injury. Further research is required to evaluate the performance of the craniocaudal view in the diagnosis of Lisfranc injury. Overall, the available studies' methodological quality was satisfactory. If clinical suspicion of a Lisfranc injury persists after inconclusive radiographs; computed tomography (CT) is the next line of imaging. Epidemiology and outcomes of Lisfranc injuries identified at the National Football League Scouting Combine. An Intera Achieva 1.5-T magnetic resonance machine (PHILIPS, Holland) was used, which was equipped with a high-resolution knee coil. The tarsometatarsal (TMT), or Lisfranc, joint complex is the attachment between the forefoot and midfoot. Free shipping for many products! Injury. 2016;26:305. Google Scholar. A Lisfranc injury occurs secondary to disruption of a major stabilizing ligament of the arch of the foot. Its structure is of great significance for the weight-bearing function of the foot. 2019 February 15; 14: 50, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://www.ncbi.nlm.nih.gov/pubmed/?term=Olerud+C%2C+Rosendahl+Y.+Torsiontransmitting+properties+of+the+hind+foot.+Clin+Orthop.+1987%3B(214)%3A285%E2%80%9394, Lisfranc distance of ligament starting point to entocuneiform base (mm), Lisfranc angle between the Lisfranc ligament and the long axis of the first metatarsal bone(). The ePub format is best viewed in the iBooks reader. To systematically review current diagnostic imaging options for assessment of the Lisfranc joint. https://doi.org/10.1007/s00256-019-03282-1. After an immediate post-game report suggesting a season-ending fracture, it's possible further imaging studies did not show a more severe Lisfranc injury. Reassuringly, all seven false-negative cases were treated by plaster immobilization without surgery. Subtle injuries of the Lisfranc joint. 2009;14(2):16986. Skelet Radiol. Magnetic Resonance Imaging (MRI): If ligaments, tendons or other, non-bony parts of your Lisfranc joint are injured, your provider might use an MRI to get a complete picture of your foot and any damage inside it. Lisfranc injuries are sometimes mistaken for ankle sprains, making the diagnostic process very important. The Lisfranc joint is an important component of the foot arch structure. 2015;36(12):148392. Magn Reson Imaging Clin N . 2014;34(2):51431. One or more imaging tests are done to look at the bones and . 2014;104(1):118. Routine non-enhanced foot X-ray films cannot meet the requirements of the diagnosis of Lisfranc joints, especially for slight Lisfranc joint subluxation, causing the missed diagnosis rate to be as high as 1020% [17]. The ePub format uses eBook readers, which have several "ease of reading" features Overall, the available studies methodological quality was satisfactory. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. B, Anteroposterior (A) and oblique (B) radiographs of foot show subtle malalignment of second tarsal-metatarsal joint, which was considered equivocal for Lisfranc injury. Since the Lisfranc ligament distributes obliquely, its display is generally poor. The oblique cross-section can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. Incidence Increased incidence in athletes secondary to greater appreciation and recognition Four percent of college football players per year Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. Meniscal Cyst 37. Philbin T, Rosenberg G, Sferra JJ. 8600 Rockville Pike Lisfranc Injury Imaging and Surgical Management. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Imaging of the Lisfranc injury Lisfranc ligament and joint injuries are relatively uncommon but can result from a variety of low- and high-impact trauma. 1). Skelet Radiol. 1997;18(6):3515. J Pediatr Orthop. J Orthop Surg Res. . Federal government websites often end in .gov or .mil. Unfortunately, the term is imprecise. The reason is that the location of the Lisfranc ligament is deep, and its length is short; hence, its injury is more difficult to diagnose. Christopher K Bromley, DPM, FACFAS discusses the origin of Lisfranc's naming history, basic anatomy as well as imaging evaluation to make a diagnosis of a Lisfranc joint injury. 1970;56(4):30324. Imaging in Lisfranc injury: a systematic literature review. Meta-analysis in medical research. The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. A Lisfranc injury is an injury of the midfoot that can cause pain and impair your ability to walk. Sixty patients were examined by CT over a 1-year period in the assessment of significant midfoot injury. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments. The mean CT measurement of the 60 patients was 28.9 5.7 (range, 1638). Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. Detailed imaging parameters of the Lisfranc joint and ligament were obtained from the present imaging experiment, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries. Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. The page or action you requested has resulted in an error. The institutions ethics review board did not require ethical review for this retrospective analysis of imaging data obtained as part of the patients normal clinical care. Timely and accurate diagnosis of the injury and early anatomical reduction and stabilization of the Lisfranc joint are crucial to avoid long-term sequelae and functional impairment. Tafur M, Rosenberg ZS, Bencardino JT. CT is, however, favored as it will also demonstrate unsuspected associated fractures. Psoriatic Arthritis 40. A total of 30 adult volunteers were enrolled. In particular, three-dimensional reconstruction technology has great advantages in the diagnosis of micro fractures and small dislocations of the foot. In our study, we used the software program SPSS 20.0 to conduct the statistical analysis. Ann Intern Med. 1). The authors declare that they have no competing interests. This structure is also an important part in maintaining Lisfranc joint stability. Vuori JP, Aro HT. The outcomes of our study showed that the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. I Injury to the Lisfranc joint (Tarsometatarsal joint) is a rare event with reported incidence of 0.1 to 0.4% of fracture cases [1]. CT was performed on a 64-MDCT scanner using 1.25-mm slice thickness. They are more commonly used in the case of delayed diagnosis. Standard surgical practice is to perform open reduction and internal fixation to anatomically realign the joint when there is joint malalignment due to either dislocation or disruption of the articular surface. Alexej Barg. Goiney RC, Connell DG, Nichols DM. Careers. 1996;199(3):7336. Secondly, this was an observational trial without control group. The Lisfranc ligament, Lisfranc, Magnetic resonance imaging, Oblique coronal, Graphic interpretations: (1) MRI scanning images of the sagittal section; (2) MRI scanning images of the oblique transverse section, where the arrow indicates the Lisfranc ligament; (3) height measurement of the Lisfranc ligament; (4) width measurement, Journal of Orthopaedic Surgery and Research. Lisfranc Joint Ligamentous Complex: MRI With Anatomic Correlation in Cadavers, Review. Please remove adblock to help us create the best medical content found on the Internet. This article has been corrected. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. Typical signs of a Lisfranc injury include: Pain/tenderness throughout the midfoot when standing or when pressure is applied. https://doi.org/10.1007/s00256-019-03282-1, DOI: https://doi.org/10.1007/s00256-019-03282-1. In very rare cases, medial dislocation of the first metatarsal can occur without disruption of the second metatarsal, a condition that provides little diagnostic difficulty on the radiograph. The sagittal CT section of the phantom (Fig. (3) Main parameters: T1-vibe was set as the T1 contrast sequence, and FLASH was set as the T2 check sequence. Clipboard, Search History, and several other advanced features are temporarily unavailable. CAS Signs are often more apparent on the oblique view of the foot. 1976;120(1):7983. PubMed and ScienceDirect were systematically searched. Foot Ankle Int. Advanced spiral CT post-processing technique can comprehensively observe fractures and dislocations of the midfoot. Two of the false-positives were considered as showing definite evidence of Lisfranc injury on radiographs. Lisfranc Fracture-Dislocation 35. 2009;28(3):3517. There were seven false-negative and three false-positive radiographs. Mahmoud S, Hamad F, Riaz M, Ahmed G, Al Ateeq M, Ibrahim T. Int Orthop. The site is secure. Foot Ankle Int. Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA. Macmahon PJ, Dheer S, Raikin SM, Elias I, Morrison WB, Kavanagh EC, et al. Because Lisfranc injuries are relatively rare, only representing 0.2% of all fractures, with an estimated incidence of 1/55 000 people, there continues to be an ongoing debate on the ideal management of such injuries. CT reveals the joint in the optimum plane without the difficulty of overlapping shadows found on the radiograph. The functionality is limited to basic scrolling. Rankine JJ, Nicholas CM, Wells G, et al. Treatment of Lisfranc joint injury: current concepts. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Pattern of the Month. X-Ray: anteroposterior (A-P), a 30-degree oblique, and a lateral view of the foot are required. Radiographs of the phantom were obtained, using a standard digital radiographic system, with the standard AP foot projection and at increments of 5 of craniocaudal tube angulation up to 35. There may be bruising on both the top and bottom of the foot. J Bone Joint Surg Am. The . Preidler KW, Brossmann J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. 2001;22(8):63741. This procedure usually involves a surgeon using permanent or temporary hardware. The foot was scanned in a standard position with the patient supine and the ankle in a neutral position, with the plantar surface at 90 to the horizontal. The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. In addition to anteroposterior weight-bearing radiographs, lateral weight-bearing radiographs have been reported as showing flattening of the longitudinal arch in the delayed diagnosis of Lisfranc injury [3]. The https:// ensures that you are connecting to the 1 Jacques L. Lisfranc was a French surgeon during the Napoleonic wars who described an injury to the midfoot that resulted when men fell . It is designed with a motion-control technology along with a ROLLBAR stability post system. Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. The eight images were assessed independently by the two observers and by consensus opinion, while blinded to the degree of angulation, and the image that best revealed the tarsal-metatarsal joint of the second metatarsal was selected. Leenen LP, van der Werken C. Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study. Physical exam findings, including deformity, swelling and ecchymosis, may be subtle or absent. Common examples would include being involved in a motor vehicle accident or forklift accident, when . . . 2007;38(7):85660. New Balance Men's 813 V1 Hook and Loop Walking Shoe. These injuries are well demonstrated on the standard views of the foot. 2016 Apr;20(2):139-53. doi: 10.1055/s-0036-1581119. On the anteroposterior radiograph, the joint is not visualized as it lies oblique to the x-ray beam. Conventional radiographs miss a significant number of cases of Lisfranc injury. Sripanich, Y., Weinberg, M.W., Krhenbhl, N. et al. Imaging tests are the best way to confirm a diagnosis of a Lisfranc injury. RESULTS. Pain that worsens with standing, walking or attempting to push off on the affected foot. On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. Conversely, there were two false-positive CT examinations in our series, but false-positives have also been described with MRI [11]. Classification . Diagnosis can be made with plain film radiographs . The foot was placed in the knee coil, and sandbags were placed around the foot for fixation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. 2017;25(7):46979. Subtle capsular avulsions involving the tarsal-metatarsal joint were taken as evidence of potential Lisfranc injury. The most common symptoms of Lisfranc injury include: The top of foot may be swollen and painful. Please enable it to take advantage of the complete set of features! The most common radiographic findings include diastasis of the base of the Injury pattern in ligamentous Lisfranc injuries in competitive athletes. Abduction stress radiography under anesthesia is often considered the reference standard for the diagnosis [8]. Epub 2014 May 10. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. Please go back to the previous page by using your browser's Back button, or visit the Home Page. Therefore, misdiagnosis and missed diagnosis easily occur. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. After acquisition of MRI images, data were burned into a CD, and the morphology and structure of the Lisfranc ligament on the MRI image were observed and described. In conclusion, to our knowledge, this is the largest series published to date investigating the performance of radiographs in the diagnosis of Lisfranc injury. MR imaging of the midfoot including Chopart and Lisfranc joint complexes. Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC. This study received funding from the National Institute for Health Research. Received 2018 Apr 26; Accepted 2018 Aug 31. Science supports Xinjiang projects plan project of Xinjiang Uygur Autonomous Region (Title: Applied anatomy and biomechanical research to plantar tarsal joint stability maintenance structure) project number: 2013911112. PubMedGoogle Scholar. Preidler KW, Wang YC, Brossmann J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MR images. EXTERNAL ROTATION on a pronated forefoot (makes the MOST unstable injuries) Hippokratia. common injuries in athletes. Groulier P, Pinaud JC. Imaging for a Lisfranc injury may include X-rays to show any broken bones and the alignment of the Lisfranc joint complex. Still, subtle injuries may be missed and require further imaging such as CT, MRI or radiographic stress views with forefoot abduction. Screw fixation for lisfranc injury Research When Is Surgery Needed? In order to determine the effective method for preventing and treating this disease, it is necessary to proceed with more large-scale clinical studies. The severity of this orthopaedic condition can range from minor to complex if many joints are involved. 1981;137(6):11516. McHale KJ, Vopat BG, Beaulieu-Jones BR, Sanchez G, Whalen JM, McDonald LS, et al. The authors have no conflicts of interest to declare. The CT examination was reported as either normal or positive for Lisfranc injury using the same diagnostic criteria that applied to the radiographic evaluation. The CT measurement of the phantom showed 20 angulation of the joint. If the 13 equivocal cases were counted as negative for Lisfranc injury, the sensitivity reduced but the specificity increased (sensitivity, 68.9%; specificity, 80%; positive predictive value, 91.1%; negative predictive value, 46.1%). 2015;54(5):8837. Figures 3A, 3B, 3C, 3D, 3E, 3F, 3G, and 3H shows the appearances of the joint at varying degrees of craniocaudal angulation. Foster SC, Foster RR. stephenf.hatem,md ''lisfranc'' is one of the best known orthopedic eponyms.unfortunately,thetermisimprecise.lis- franc is applied to a multitude of normal structures andvariousinjuries: thelisfrancjoint,lisfrancliga- ment,lisfrancinjury,andlisfrancfracture-subluxa- tionordislocation.jacqueslisfranc,afieldsurgeon in napolean's army, described none Recently, Thierfelder et al. Skelet Radiol. Written informed consent was obtained from all participants. the display of certain parts of an article in other eReaders. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice. According to WebMD, a Lisfranc injury happens when "[an individual damages their] . [19] reported the MR imaging features of common osseous, tendon, and ligament abnormalities that affect the midfoot and also presented that MRI plays an important role in the early diagnosis of Lisfranc Ligament. The tarsal-metatarsal joint of the second metatarsal lies oblique to the x-ray beam on the anteroposterior radiograph, and we have shown that a craniocaudal angulation of 28.9 would optimally reveal the joint in a population of patients being investigated for midfoot injury. Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. Woodward S, Jacobson JA, Femino JE, Morag Y, Fessell DP, Dong Q. Sonographic evaluation of Lisfranc ligament injuries. This is a preview of subscription content, access via your institution. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. In a more severe injury, the foot may be distorted and putting weight on it may be very painful. A clinical and experimental study of tarsometafarsal dislocations and fracture-dislocations. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Twenty of the 45 CT-positive cases (44.4%) were taken to the surgery department. Epub 2016 Jun 23. The sensitivity of subtle injuries was lower than severe injuries (65.4% vs 87.1% p = 0.003).Conclusions Diagnosis of Lisfranc injury based on non-weight-bearing radiographs has moderate agreement . Despite the fact that both radiologists were experienced in musculoskeletal imaging, only 68.9% of cases were identified on the radiographs. You may switch to Article in classic view. sharing sensitive information, make sure youre on a federal All seven false-negative cases were treated conservatively. 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