Sonographic evaluation of Lisfranc ligament injuries.
OBJECTIVE
This study characterized the sonographic appearances of Lisfranc injuries.


METHODS
Sonography reports (2000-2007) were searched for "Lisfranc," resulting in 10 patients. Sonographic images of affected and asymptomatic contralateral feet were reviewed, recording the thickness of the dorsal ligament between the first (medial) cuneiform (C1) and second metatarsal (M2) ligaments, distance between C1 and M2, and change in this distance with weight bearing, hyperemia, and fractures. Correlations were made to clinical, surgical, and other imaging findings.


RESULTS
In 5 asymptomatic feet, the dorsal C1-M2 ligament was 0.9 to 1.2 mm thick, and the C1-M2 distance was 0.5 to 1 mm. Of the symptomatic feet, 1 group (n=3) had normal sonographic findings (thickness, 0.9-1.1 mm; distance, 0.6-0.7 mm; all had normal radiographic findings and follow-up, and 1 had normal magnetic resonance imaging [MRI] findings). Another group (n=3) had abnormal hypoechogenicity and thickening of the dorsal C1-M2 ligament (1.4-2.3 mm), a normal C1-M2 distance (0.6-0.7 mm), and no widening with weight bearing (1 of 1), consistent with a ligament sprain (1 had normal computed tomographic [CT] findings, and all had uneventful follow-up). The third group (n=4) had nonvisualization of the dorsal C1-M2 ligament, an increased C1-M2 distance of 2.5 to 3.1 mm, and further widening with weight bearing (3 of 4) from Lisfranc ligament disruption (shown at surgery in 2, MRI in 1, and CT in 1).


CONCLUSIONS
Nonvisualization of the dorsal C1-M2 ligament and a C1-M2 distance of 2.5 mm or greater were indirect signs of a Lisfranc ligament tear. Dynamic evaluation with weight bearing showed widening of the space between C1 and M2.
Woodward
Suzanne
S
Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109-0326, USA.
Jacobson
Jon A
JA
Femino
John E
JE
Morag
Yoav
Y
Fessell
David P
DP
Dong
Qian
Q
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013640:Tarsal Joints / Q000000981:diagnostic imaging* / Q000293:injuries*; D014463:Ultrasonography; D055815:Young Adult