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Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Subtle Lisfranc joint injuries remain challenging to diagnose in clinical practice. Although of questionable accuracy, bilateral weightbearing radiographs are considered the current gold standard to assess these injuries. However, weightbearing computed tomography (WBCT), which provides clearer visualization of bony landmarks, can also be used for evaluation. This study aims to design a protocol that reliably measures the distance between the medial cuneiform (C1) and second metatarsal (M2) to assess the Lisfranc joint using WBCT imaging.

Methods

Two unique methods of measuring the C1–M2 distance were designed that localize the center of the interosseous Lisfranc ligament (ILL, reference point). This reference point was located by (I) measuring a specific distance at the M2 base, or (II) approximating from nearby bony landmarks, on both axial (Ax) and coronal (Cor) WBCT images. Four parameters (I-Ax, I-Cor, II-Ax, and II-Cor) were evaluated for each of 96 specimens. Measurements were recorded by three independent observers and repeated for inter- and intra-observer agreement.

Results

In total, 96 patient image series were included and assessed in our study with an average age of 46 (19–66, SD 16.1) and average BMI of 25.8 (17.8–30.5, SD 4.3). I-Ax showed excellent agreement for intra-observer evaluation (R = 0.802) and good agreement for inter-observer evaluation (R = 0.727). I-Cor demonstrated excellent inter- (R = 0.814) and intra-observer (R = 0.840) agreement. Good agreement was found for both II-Ax and II-Cor for both intra- (R = 0.730, R = 0.708) and inter-observer (R = 0.705, R = 0.645) evaluation.

Conclusion

Measuring the C1–M2 joint space with coronal WBCT imaging through a protocol that localizes the ILL is reproducible, simple, and can potentially be utilized clinically to evaluate the Lisfranc joint.

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Acknowledgements

The authors wish to thank Sebastian Drago Perez and Jesse Steadman for their assistance in measuring applicable study parameters and preparing this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Yantarat Sripanich, Maxwell W. Weinberg, Nicola Krähenbühl, Charles L. Saltzman & Alexej Barg

  2. Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand

    Yantarat Sripanich & Chamnanni Rungprai

Authors
  1. Yantarat Sripanich
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Correspondence to Alexej Barg.

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This study was approved by the internal institutional review board of the University of Utah (IRB #00071733).

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Sripanich, Y., Weinberg, M.W., Krähenbühl, N. et al. Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg 141, 775–781 (2021). https://doi.org/10.1007/s00402-020-03477-5

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