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Sonographic Evaluation of Lisfranc Ligament Injuries

Department of Radiology, University of Michigan, Ann Arbor, Michigan USA (S.W., J.A.J., Y.M., D.P.F., Q.D.); and Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa USA (J.E.F.).

Address correspondence to Jon A. Jacobson, MD, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0326 USA., E-mail: jjacobsn{at}umich.edu

Objective. This study characterized the sonographic appearances of Lisfranc injuries. Methods. Sonography reports (2000–2007) were searched for "Lisfranc," resulting in 10 patients. Sonographic images of affected and asymptomatic contralateral feet were reviewed, recording the thickness of the dorsal ligament between the first (medial) cuneiform (C1) and second metatarsal (M2) ligaments, distance between C1 and M2, and change in this distance with weight bearing, hyperemia, and fractures. Correlations were made to clinical, surgical, and other imaging findings. Results. In 5 asymptomatic feet, the dorsal C1-M2 ligament was 0.9 to 1.2 mm thick, and the C1-M2 distance was 0.5 to 1 mm. Of the symptomatic feet, 1 group (n = 3) had normal sonographic findings (thickness, 0.9–1.1 mm; distance, 0.6–0.7 mm; all had normal radiographic findings and follow-up, and 1 had normal magnetic resonance imaging [MRI] findings). Another group (n = 3) had abnormal hypoechogenicity and thickening of the dorsal C1-M2 ligament (1.4–2.3 mm), a normal C1-M2 distance (0.6–0.7 mm), and no widening with weight bearing (1 of 1), consistent with a ligament sprain (1 had normal computed tomographic [CT] findings, and all had uneventful follow-up). The third group (n = 4) had nonvisualization of the dorsal C1-M2 ligament, an increased C1-M2 distance of 2.5 to 3.1 mm, and further widening with weight bearing (3 of 4) from Lisfranc ligament disruption (shown at surgery in 2, MRI in 1, and CT in 1). Conclusions. Nonvisualization of the dorsal C1-M2 ligament and a C1-M2 distance of 2.5 mm or greater were indirect signs of a Lisfranc ligament tear. Dynamic evaluation with weight bearing showed widening of the space between C1 and M2.

Key Words: foot • ligament • sonography • trauma

Abbreviations: C1, first cuneiform • CT, computed tomography • MRI, magnetic resonance imaging • M2, second metatarsal