Talaski Grayson M, Mallavarapu Vineel, Behrens Andrew, Mansur Nacime, Aiyer Amiethab, Anastasio Albert T, Lintz François, de Cesar Netto Cesar
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
Department of Orthopedic Surgery, Duke University, Durham, NC, USA.
Foot Ankle Int. 2025 Jun;46(6):644-651. doi: 10.1177/10711007251328693. Epub 2025 Apr 22.
Injury to the Lisfranc complex can prove difficult to diagnose, particularly injuries that are purely ligamentous. Missed Lisfranc injuries can cause long-lasting consequences including accelerated midfoot arthritis and collapse. Previous studies have investigated the volume and area of the space between the medial cuneiform and the second metatarsal, but the Lisfranc complex involves additional joints whose articulations have yet to be described. The objective of this study was to define volumes of each individual Lisfranc joint under physiological load to establish healthy baselines for clinical reference.
Forty-three volunteers (54 feet) receiving a weightbearing computed tomography (CT) scan were included in this study. This cohort included 11 bilateral and 32 unilateral feet in patients that were scanned because of the presence of a contralateral ankle injury. The images were segmented using a semiautomated segmentation method. Opposing articular spaces in the Lisfranc joint of the midfoot were manually selected, and interarticular distance mapping was then performed to characterize the joint space width. Interarticular volume was then estimated using an area-weighted volume measurement.
All articulating surfaces within the tarsometatarsal region of the Lisfranc complex had a coefficient of variance below 30%, with the least variable region corresponding to the medial cuneiform-intermediate cuneiform articulating space (19.4%) and the most variable tarsometatarsal region corresponding to the medial cuneiform-second metatarsal (28.1%). Bilateral volunteers (n = 11) had nonsignificant contralateral differences in every articulating space within the Lisfranc complex except for the first metatarsal-medial cuneiform joint where we identified an average contralateral difference of 3.61 mm, = .03.
We present our data on using a semiautomatic algorithm to estimate volume of midfoot joints from weightbearing CT scan in a cohort of noninjured control subjects. Further studies determining if this algorithm may have clinical utility to help identify subtle Lisfranc instability are needed.
Lisfranc复合体损伤可能难以诊断，尤其是单纯韧带损伤。漏诊的Lisfranc损伤会导致长期后果，包括中足关节炎加速和塌陷。以往的研究调查了内侧楔骨与第二跖骨之间间隙的容积和面积，但Lisfranc复合体还涉及其他关节，其关节连接尚未得到描述。本研究的目的是确定在生理负荷下每个Lisfranc关节的容积，以建立健康基线供临床参考。
本研究纳入了43名接受负重计算机断层扫描（CT）的志愿者（54只脚）。该队列包括11例双侧脚和32例单侧脚，这些患者因对侧踝关节损伤而接受扫描。使用半自动分割方法对图像进行分割。手动选择中足Lisfranc关节的相对关节间隙，然后进行关节间距离映射以表征关节间隙宽度。然后使用面积加权体积测量法估计关节间体积。
Lisfranc复合体跗跖区域内的所有关节面变异系数均低于30%，变异最小的区域对应于内侧楔骨-中间楔骨关节间隙（19.4%），变异最大的跗跖区域对应于内侧楔骨-第二跖骨（28.1%）。双侧志愿者（n = 11）在Lisfranc复合体内的每个关节间隙中，对侧差异均无统计学意义，但第一跖骨-内侧楔骨关节除外，我们发现该关节的对侧平均差异为3.61 mm，P = .03。
我们展示了在一组未受伤的对照受试者中，使用半自动算法从负重CT扫描估计中足关节体积的数据。需要进一步研究确定该算法是否可能具有临床实用性，以帮助识别细微的Lisfranc不稳定。
