Ghandour Samir, Bhimani Rohan, Yahya Ayesha, Eltouny Ehab, Guss Daniel, Waryasz Gregory, Vicentini J Rafael T, Ashkani-Esfahani Soheil, Stewart Zachary E
Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA.
The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA.
Skeletal Radiol. 2025 Mar;54(3):543-552. doi: 10.1007/s00256-024-04771-8. Epub 2024 Aug 13.
To assess if Lisfranc injury can be detected by US with and without abduction stress.
Eight cadaveric feet were obtained. The following measurements were obtained in the uninjured feet: C1M2 and C1C2 intervals and TMT1 and TMT2 dorsal step-off distances. Measurements were obtained both with and without abduction stress using ultrasound. The injury model was created by transecting the Lisfranc ligament complex, after which the observers performed the measurements again. Statistical analysis was used to identify differences between intact and injured models, to determine diagnostic cut-off values for identifying Lisfranc injuries, and to assess interobserver/intraobserver reliability.
There was a significant difference in the mean C1M2 interval, both with and without abduction stress, between the intact and torn Lisfranc ligament (p < 0.001). A C1M2 interval with stress of > 2.03 mm yielded 81% sensitivity and 72% specificity for Lisfranc disruption. There was no significant difference in the mean C1C2 interval of the torn versus intact Lisfranc ligament without stress (p = 0.10); however, the distance was significantly different with the application of stress (p < 0.001). The C1C2 interval of > 1.78 mm yielded 72% sensitivity and 69% specificity for Lisfranc injury under stress. There were no significant differences in the mean TMT1 or TMT2 dorsal step-off measurements between the intact and torn Lisfranc ligaments. All observers showed good intraobserver ICCs. The interobserver ICCs for all measurements were good or excellent, except for TMT1, which was moderate.
Ultrasonography is a promising point-of-care imaging tool to detect Lisfranc ligamentous injuries when measuring C1M2 and C1C2 distances under abduction stress.
评估在施加和不施加外展应力的情况下，超声能否检测出Lisfranc损伤。
获取8只尸体足。在未受伤的足部进行以下测量：C1M2和C1C2间距以及TMT1和TMT2背侧台阶距离。使用超声在施加和不施加外展应力的情况下进行测量。通过横断Lisfranc韧带复合体建立损伤模型，之后观察者再次进行测量。采用统计分析来确定完整模型与损伤模型之间的差异，确定识别Lisfranc损伤的诊断临界值，并评估观察者间/观察者内的可靠性。
完整和撕裂的Lisfranc韧带在施加和不施加外展应力时，平均C1M2间距均存在显著差异（p < 0.001）。应力作用下C1M2间距> 2.03 mm时，Lisfranc韧带断裂的敏感度为81%，特异度为72%。无应力时，撕裂与完整的Lisfranc韧带平均C1C2间距无显著差异（p = 0.10）；然而，施加应力时该距离有显著差异（p < 0.001）。应力作用下C1C2间距> 1.78 mm时，Lisfranc损伤的敏感度为72%，特异度为69%。完整和撕裂的Lisfranc韧带之间，TMT1或TMT2背侧台阶测量的平均值无显著差异。所有观察者均显示出良好的观察者内ICC值。除TMT1为中等外，所有测量的观察者间ICC值均为良好或优秀。
超声检查是一种很有前景的床旁成像工具，在施加外展应力时测量C1M2和C1C2距离，可检测Lisfranc韧带损伤。
