Grün Wolfram, Vermorel Pierre-Henri, Luo Emily J, Yang Daniel, Pozzessere Enrico, Talaski Grayson M, Lintz Francois, de Cesar Netto Cesar
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway.
Foot Ankle Orthop. 2025 Sep 25;10(3):24730114251372593. doi: 10.1177/24730114251372593. eCollection 2025 Jul.
Lisfranc injuries pose diagnostic challenges, particularly in evaluating joint stability. Conventional weightbearing computed tomography (WBCT)-based distance measurements of the C1-M2 interval fail to account for the second metatarsal's triplanar orientation, potentially leading to inaccuracies. This study introduces a new 3D-corrected triplanar measurement method correcting for axial, coronal, and sagittal alignment to improve diagnostic accuracy.
In this retrospective study, 31 patients with acute Lisfranc injuries underwent bilateral WBCT. Injuries were defined based on radiographic findings in the first to third tarsometatarsal joints and the C1-M2 interval. Two fellowship-trained foot and ankle surgeons independently performed manual measurements using a previously described uniplanar method and a new triplanar technique, applied proximally and distally in the C1-M2 interval. Intra- and interrater reliability were assessed via intraclass correlation coefficients (ICCs), and side-to-side differences were compared using paired statistical tests.
The triplanar method demonstrated higher ICCs (intraobserver: 0.96-0.97; interobserver: 0.94-0.97) than the uniplanar method (intraobserver: 0.86-0.91; interobserver: 0.84-0.90), with distal measurements showing the highest reliability. Notably, the uniplanar method incorrectly measured the M1-M2 interval instead of the intended C1-M2 interval in 22.6% of injured feet. No such errors occurred in contralateral feet or with the triplanar method, which demonstrated 100% intra- and interobserver agreement. All 6 performed C1-M2 measurements showed significant differences between injured and contralateral feet ( < .05). The triplanar method applied distally in the coronal plane yielded the greatest absolute side-to-side difference (1.81 mm, SD 1.60).
This study demonstrates excellent intra- and interobserver reliability for a novel WBCT-based method that realigns the measurement planes with the second metatarsal rather than the floor. This method improves measurement precision and prevents systematic errors observed with previous techniques, particularly the misidentification of the M1-M2 interval using uniplanar methods. Clinical validation studies correlating measurements with surgical outcomes are needed to establish diagnostic thresholds and confirm clinical utility.
Level III, retrospective diagnostic study.
Lisfranc损伤在诊断方面存在挑战，尤其是在评估关节稳定性时。基于传统负重计算机断层扫描（WBCT）测量的C1-M2间隙距离未考虑第二跖骨的三平面方向，可能导致测量不准确。本研究引入了一种新的三维校正三平面测量方法，对轴向、冠状面和矢状面进行校正，以提高诊断准确性。
在这项回顾性研究中，31例急性Lisfranc损伤患者接受了双侧WBCT检查。根据第一至第三跗跖关节的影像学表现和C1-M2间隙定义损伤情况。两名接受过足踝专科培训的外科医生分别使用先前描述的单平面方法和一种新的三平面技术，在C1-M2间隙的近端和远端进行手动测量。通过组内相关系数（ICC）评估测量者内和测量者间的可靠性，并使用配对统计检验比较双侧差异。
三平面方法的ICC值（测量者内：0.96 - 0.97；测量者间：0.94 - 0.97）高于单平面方法（测量者内：0.86 - 0.91；测量者间：0.84 - 0.90），其中远端测量的可靠性最高。值得注意的是，在22.6%的受伤足部中，单平面方法错误地测量了M1-M2间隙而非预期的C1-M2间隙。在对侧足部或采用三平面方法时未出现此类错误，三平面方法在测量者内和测量者间的一致性为100%。所有6次进行的C1-M2测量均显示受伤侧与对侧足部之间存在显著差异（P < 0.05）。在冠状面远端应用三平面方法时，双侧绝对差异最大（1.81 mm，标准差1.60）。
本研究表明，一种基于WBCT的新方法具有出色的测量者内和测量者间可靠性，该方法使测量平面与第二跖骨而非地面重新对齐。这种方法提高了测量精度，避免了先前技术中出现的系统误差，特别是使用单平面方法时对M1-M2间隙的错误识别。需要进行将测量结果与手术结果相关联的临床验证研究，以确定诊断阈值并确认临床实用性。
III级，回顾性诊断研究。
