Retrospective chart review: Weightbearing CT scans and the measurement of the Lisfranc ligamentous complex

Falcon, Spencer; McCormack, Thomas J.; Mackay, Matt; Wolf, Megan R.; Baker, Jordan; Tarakemeh, Armin; Everist, Brian M.; Mullen, Scott; Schroeppel, John Paul; Vopat, Bryan G.

doi:10.1016/j.fas.2022.08.011

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…Falcon et al 7 used WBCT to examine healthy feet (n = 15) as well as feet with confirmed Lisfranc injuries (n = 96) and found a significantly greater M1-M2 distance in injured feet as compared to controls (3.3 ± 0.9 mm vs 2.75 ± 0.7 mm; P < .0001). The same study found greater C1-M2 distance in injured than healthy feet ( P < .0001), but found no significant difference in C1-second cuneiform (C2) distance ( P = .6186) or sagittal descent ( P = .1916).…”

Section: Resultsmentioning

confidence: 99%

“…The same study found greater C1-M2 distance in injured than healthy feet ( P < .0001), but found no significant difference in C1-second cuneiform (C2) distance ( P = .6186) or sagittal descent ( P = .1916). 7…”

Section: Resultsmentioning

confidence: 99%

“…One article did not report the number of patients for the LF cohort (n = 15 feet) with an average age of 39.5 years. 7 Refer to Table 2 for article, patient demographic information, and outcome measurements.…”

Section: Resultsmentioning

confidence: 99%

“…18 The mean MINORS score for the 9 included articles was 12.4 ± 3.4 (range: 8.0-16.0). 1,5,7,13,16,19,20,22,25 Six articles were retrospective observational studies, and 3 articles were cadaveric studies.…”

Section: Initial Search Results and Quality Gradingmentioning

confidence: 99%

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Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature

Talaski,

Baumann,

Walley

et al. 2023

Foot & Ankle Orthopaedics

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Background Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic resonance imaging (MRI), and conventional computed tomography (CT) scan to differentiate Lisfranc instability, but they focused on a healthy/injured scale without differentiating subtle injury. Weightbearing CT (WBCT) has emerged as a diagnostic tool for detecting subtle Lisfranc injuries. This systematic review aimed to compare WBCT with conventional CT in diagnosing Lisfranc injury, and the ability to differentiate injuries of varying severities. Methods: The review encompassed PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases from inception until July 5, 2023. Inclusion criteria involved studies on CT and/or WBCT for Lisfranc injuries and nonoperative studies. Exclusion criteria composed case reports, commentaries, postoperative imaging studies, pediatric patients, studies with nonobjective radiographic measurements, studies exclusively focused on injury classification, and studies with fewer than 5 patients because of poor statistical power. Data extraction focused on radiographic measurements of the Lisfranc complex, categorized into conventional CT, partial WBCT, and total WBCT. Results: Out of the initially retrieved 489 articles, 9 met the inclusion criteria. Several studies consistently demonstrate that WBCT provides a higher level of accuracy in measuring the Lisfranc area, offering enhanced sensitivity to detect subtle alterations in joint structure. Moreover, WBCT exhibits superior sensitivity in distinguishing between healthy Lisfranc joints and those with injuries, particularly when identifying dorsal ligament damage. This imaging modality allows for the detection of significant variations in critical measurements like first-second metatarsal (M1-M2) distance, first cuneiform (C1)-M2 distance, and joint volumes, enabling a more comprehensive assessment of Lisfranc joint health especially with subtle instability. Conclusion This review evaluates the extant literature on WBCT’s utility in diagnosing Lisfranc injuries and compares its effectiveness to CT in distinguishing between injuries of varying severity. WBCT, with reliable measurement techniques, appears more adept at detecting subtle Lisfranc instability compared to CT, likely by allowing the assessment of injury under load.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Initial Search Results and Quality Gradingmentioning

confidence: 99%

See 2 more Smart Citations

Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature

Talaski,

Baumann,

Walley

et al. 2023

Foot & Ankle Orthopaedics

View full text Add to dashboard Cite

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“…Shim et al argued that the diagnostic validity of bilateral CT is similar to that of bilateral weight‐bearing radiographs [21]. Weight‐bearing CT, a growing emerging technology, displays a strong potential for detecting subtle changes and revealing latent injuries [22, 23]. Bhimani et al used three‐dimensional volumetric measurements from weight‐bearing CT to detect Lisfranc instability with a higher sensitivity (91.6%–92.3%) and specificity (96.5%–97.7%) than those detected using two‐ and one‐dimensional measurements [24].…”

Section: Discussionmentioning

confidence: 99%

Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable?

Chen

Jiang

Wang

et al. 2023

Journal of Foot and Ankle Research

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Background Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Most medical institutions prefer to use conventional radiography. However, existing studies on conventional radiographs in Lisfranc injury lack a large population-based sample, influencing the validity of the results. We aimed to determine the diagnostic validity and reliability of conventional radiography for Lisfranc injury and whether computed tomography can alter clinical decision-making. Methods This retrospective study included 307 patients with, and 100 patients without, Lisfranc injury from January 2017 to December 2019. Diagnosis was confirmed using computed tomography. A senior and junior surgeon independently completed two assessments of the same set of anonymised conventional radiographs at least 3 months apart. The surgeons were then asked to suggest one of two treatment options (surgery or conservative treatment) for each case based on the radiographs and subsequently on the CT images. Results All inter- and intra-observer reliabilities were moderate to very good (all κ coefficients > 0.4). The mean (range) true positive rate was 81.8% (73.9%–87.0%), true negative rate was 90.0% (85.0%–94.0%), false positive rate was 10.0% (6.0%–15.0%), false negative rate was 18.2% (13.0%–26.1%), positive predictive value was 96.1% (93.8%–97.8%), negative predictive value was 62.4% (51.5%–69.7%), classification accuracy was 83.8% (76.7%–88.2%), and balanced error rate was 14.1% (10.2%–20.5%). Three-column injuries were most likely to be recognized (mean rate, 92.1%), followed by intermediate-lateral-column injuries (mean rate, 81.5%). Medial-column injuries were relatively difficult to identify (mean rate, 60.7%). The diagnostic rate for non-displaced injuries (mean rate, 76.7%) was lower than that for displaced injuries (mean rate, 95.5%). The typical examples are given. A significant difference between the two surgeons was found in the recognition rate of non-displaced injuries (p = 0.005). The mean alteration rate was 21.9%; the senior surgeon tended to a lower rate (15.6%) than the junior one (28.3%) (p < 0.001). Conclusions The sensitivity, specificity, and classification accuracy of conventional radiographs for Lisfranc injury were 81.8%, 90.0%, and 83.8%, respectively. Three-column or displaced injuries were most likely to be recognized. The possibility of changing the initial treatment decision after subsequently evaluating computed tomography images was 21.9%. The diagnostic and clinical decision-making of surgeons with different experience levels demonstrated some degree of variability. Protected weight-bearing and a further CT scan should be considered if a Lisfranc injury is suspected and conventional radiography is negative.

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Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies

Li,

Fang,

Van Oevelen

et al. 2024

Foot and Ankle Surgery

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Retrospective chart review: Weightbearing CT scans and the measurement of the Lisfranc ligamentous complex

Cited by 5 publications

References 25 publications

Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature

Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature

Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable?

Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies

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