Yoshimoto Kensei, Omodani Toru, Ishizuka Kotaro, Maruyama Kazunori, Kumaki Mitsuki, Noguchi Masahiko, Okazaki Ken
Department of Orthopedic Surgery Tokyo Women's Medical University Shinjuku-ku Tokyo Japan.
Orthopaedic Foot and Ankle Center Shiseikai Daini Hospital Setagaya-ku Tokyo Japan.
J Exp Orthop. 2025 Sep 9;12(3):e70434. doi: 10.1002/jeo2.70434. eCollection 2025 Jul.
Weight-bearing (WB) computed tomography or plain radiography provides the most accurate diagnosis of subtle Lisfranc injuries. However, WB is often challenging for patients due to pain, and these modalities can be inconvenient. Recently, the utility of ultrasonography (US), which enables easy and convenient assessment and bilateral comparison, has gained attention. This study aimed to assess whether US can accurately diagnose these injuries.
Twenty-five patients with subtle Lisfranc injuries, defined as a > 2 mm distance between the first cuneiform (C1) and second metatarsal (M2) on WB anteroposterior plain foot radiographs, were included in this cross-sectional study. Bilateral foot radiographs were used for intra-individual comparison, and the contralateral side was confirmed to be uninjured. US without stress or WB was performed after radiography, and the C1-M2 dorsal and articular distances were measured to assess whether this modality could accurately diagnose subtle Lisfranc injuries. Patients with uninjured contralateral feet were evaluated as healthy subjects. All patients had ligament injury and instability confirmed intraoperatively.
US measurements demonstrated strong reliability: the intraclass correlation coefficients for the C1-M2 dorsal distance were 0.91 (intra-observer) and 0.92 (inter-observer), and for the articular distance, 0.95 and 0.94, respectively. The C1-M2 dorsal and articular distances were significantly greater on the injured side. The cutoff values for the C1-M2 dorsal and articular distances in diagnosing subtle Lisfranc injury were 9.3 mm and 2.1 mm, respectively. The sensitivity and specificity of the cutoff value for the C1-M2 dorsal distance were 0.88 and 0.72, respectively, whereas those of the cutoff value for the C1-M2 articular distance were 0.76 and 0.96, respectively.
Although US examination requires experience, it demonstrated high diagnostic accuracy in detecting subtle Lisfranc injuries without the need for stress or WB imaging and showed high consistency in both intra- and inter-observer measurements of the C1-M2 distance.
Level III.
负重（WB）计算机断层扫描或X线平片能对隐匿性Lisfranc损伤做出最准确的诊断。然而，由于疼痛，负重检查对患者来说往往具有挑战性，而且这些检查方式可能不太方便。近年来，超声检查（US）因其能够轻松便捷地进行评估和双侧对比而受到关注。本研究旨在评估超声检查能否准确诊断这些损伤。
本横断面研究纳入了25例隐匿性Lisfranc损伤患者，其定义为负重位足部前后位X线平片上第一楔骨（C1）与第二跖骨（M2）之间的距离>2mm。采用双侧足部X线平片进行个体内对比，并确认对侧未受伤。在X线检查后进行无应力或负重的超声检查，测量C1-M2背侧和关节距离，以评估这种检查方式能否准确诊断隐匿性Lisfranc损伤。对侧足部未受伤的患者被评估为健康受试者。所有患者术中均证实有韧带损伤和不稳定。
超声测量显示出很强的可靠性：C1-M2背侧距离的组内相关系数，观察者内为0.91，观察者间为0.92；关节距离的组内相关系数分别为0.95和0.94。受伤侧的C1-M2背侧和关节距离明显更大。诊断隐匿性Lisfranc损伤时，C1-M2背侧和关节距离的截断值分别为9.3mm和2.1mm。C1-M2背侧距离截断值的敏感性和特异性分别为0.88和0.72，而C1-M2关节距离截断值的敏感性和特异性分别为0.76和0.96。
虽然超声检查需要经验，但它在检测隐匿性Lisfranc损伤时显示出较高的诊断准确性，无需应力或负重成像，并且在观察者内和观察者间对C1-M2距离的测量中显示出高度一致性。
III级。
