SLR - May 2023 - Sai Vemula, DPM PGY-2
Title: The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations.Reference: Kitsukawa K, Hirano T, Niki H, Tachizawa N, Mimura H. The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations. Foot and Ankle Orthopedics. 2022 Jan 21; 7(1)
Level of Evidence: Retrospective Study. Level IV, case series
Reviewed By: Sai Vemula, DPM PGY-2
Residency Program: RWJBH Community Medical Center, Toms River, NJ
Podiatric Relevance: Lisfranc injuries despite their low incidence and prevalence, have taken on significant importance due to poor long-term prognosis given the high incidence of missed initial diagnosis. It’s been a popular topic in radiology, orthopaedic surgery, and emergency medicine literature, primarily due to the subtleties of the radiographic findings and potentially dire consequences of missed diagnosis. The purpose of this study was to assess the accuracy of utilizing MRI with oblique planes and isotropic 3D MRI compared to operative findings in the setting of diagnosing acute Lisfranc ligamentous injuries relating to the Lisfranc ligament, dorsal ligament, and interosseous C1-C2 ligament.
Methods: This was a retrospective observational study consisting of data collected on 27 patients who underwent evaluation with 2D oblique plane image and isotropic 3D MRI of the Lisfranc, dorsal, and interosseous C1-C2 ligaments for acute Lisfranc joint injury, followed by a comparative intra-operative analytical reference. MRI were reviewed by 2 musculoskeletal radiologists who were blinded to the patients’ presentations and operative results.
Results: Operative findings showed that all 27 patients had a complete tear of the Lisfranc ligament, 20 (74%) had a complete tear of the dorsal ligament, and six (22%) had an interosseous C1-C2 ligament tear. While the MRI showed a Lisfranc ligament and dorsal ligament tears in all 27 patients, and a tear of the interosseous C1-C2 ligament in 12 patients. The MRI findings correlate with 100% sensitivity and accuracy for Lisfranc ligament injury, 100% sensitivity and 74% accuracy for dorsal ligament injury, and 83% sensitivity and 70% accuracy for interosseous C1-C2 ligament injury.
Conclusion: This study showed that an acute Lisfranc ligamentous injury can be accurately diagnosed by oblique plane and isotropic 3D MRI. The oblique cross-section compared to the sagittal provides a certain imaging reference that more clearly defines the entire Lisfranc ligament and visualizes in its entirety the components of this ligamentous complex. There has been only one other previous study that detailed the parameters and angulation of the ligament and this study re-affirmed the oblique nature of the ligament and provides a key imaging reference. Going forward when suspecting Lisfranc injuries, requesting an oblique cross-section appears to have an added value in assessing the personality of the tear. Furthermore, it also aids in understanding the patterns of injury, but also a way to plan for surgical correction. This is not well-understood, and more awareness of the radiographic view needs to be promoted in the hopes that it will eventually become a routine part of the MRI ordering process.