1 Methodist Sports Medicine, Indianapolis, IN, USA.
Foot Ankle Int. 2019 Feb;40(2):185-194. doi: 10.1177/1071100718802264. Epub 2018 Oct 21.
: We report data on the largest cohort to date of patients who sustained a ligamentous Lisfranc injury during sport. To date, the prevalence of concurrent intercuneiform ligament injuries in the competitive athlete with subtle Lisfranc instability has not been reported.
: Eighty-two patients (64 males, 18 females) sustained an unstable Lisfranc injury (49 left, 33 right) and met inclusion criteria. Injuries were classified as traditional dislocation (TRAD, first to second TMT ligament tear), medial column dislocation (MCD, second TMT, and medial-middle cuneiform ligament tear), or proximal extension dislocation (PE, first, second, and medial-middle cuneiform ligament tear) and the injury pattern confirmed at surgery. All athletes underwent open reduction with internal fixation (ORIF) of each unstable midfoot segment. Fisher exact tests and 2-tailed t tests were used to analyze statistical significance according to injury pattern, sport, gender difference, hindfoot angle alignment, and injured side ( P < .05).
: Average age of athletes was 21.0 ± 5.3 years old (range 12-40), and return to sports was 7.5 ± 2.1 months. Injury distribution was as follows: TRAD (n = 40), MCD (n = 17), and PE (n = 23). MCD trended toward a longer return to sport (8.4 ± 3.3 months, P = .074). Football was the most common sport at time of injury (n = 48). Wakeboard athletes (n = 5) were older (31.4 ± 3.2, P = .0002), and MCD tears were more prevalent among them ( P = .061). Basketball (n = 13) players were significantly younger (19.1 ± 2.5 years, P = .028) and returned to sports quicker (5.2 ± 0.7, P = .0002). Return to sport data indicated a typical population for athletes with Lisfranc injury in these sports.
: Proximal extension disruption (intercuneiform ligament tear) occurred in 50% of these low-energy Lisfranc athletic injuries. MCD and PE may be more prevalent than previously understood. This is the first study to document the extent, pattern, and prevalence of associated intercuneiform ligament tears in the competitive athlete with a low-energy subtle, unstable Lisfranc injury.
: Level IV, retrospective case series.
我们报告了迄今为止最大的一组在运动中遭受韧带 Lisfranc 损伤的患者的数据。迄今为止，竞争运动员中微妙 Lisfranc 不稳定伴发中间楔骨韧带损伤的患病率尚未报道。
82 名患者（64 名男性，18 名女性）遭受不稳定的 Lisfranc 损伤（49 例左侧，33 例右侧），并符合纳入标准。损伤分为传统脱位（TRAD，第一至第二 TMT 韧带撕裂）、内侧柱脱位（MCD，第二 TMT 和内侧-中间楔骨韧带撕裂）或近端延伸脱位（PE，第一、第二和内侧-中间楔骨韧带撕裂），并在手术中确认损伤模式。所有运动员均接受不稳定中足各段的切开复位内固定（ORIF）。根据损伤模式、运动、性别差异、后足角度对线和受伤侧，采用 Fisher 确切检验和双尾 t 检验分析统计学意义（P<.05）。
运动员的平均年龄为 21.0±5.3 岁（范围 12-40 岁），重返运动的时间为 7.5±2.1 个月。损伤分布如下：TRAD（n=40）、MCD（n=17）和 PE（n=23）。MCD 趋向于更长的重返运动时间（8.4±3.3 个月，P=.074）。受伤时足球是最常见的运动（n=48）。滑水板运动员（n=5）年龄较大（31.4±3.2，P=.0002），MCD 撕裂更为常见（P=.061）。篮球运动员（n=13）明显更年轻（19.1±2.5 岁，P=.028），重返运动时间更快（5.2±0.7，P=.0002）。重返运动数据表明，这些运动中 Lisfranc 损伤运动员的典型人群。
近侧延伸破坏（中间楔骨韧带撕裂）发生在这些低能量 Lisfranc 运动损伤中的 50%。MCD 和 PE 可能比以前理解的更为普遍。这是第一项记录在低能量微妙不稳定 Lisfranc 损伤的竞技运动员中，相关中间楔骨韧带撕裂的程度、模式和患病率的研究。
IV 级，回顾性病例系列。
