Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature
Authors: Talaski Grayson M. , Baumann Anthony N. , Walley Kempland C. , Anastasio Albert T. , Zirbes Christian , Cesar Netto Cesar de 
Published: December 2024

Category:

Midfoot/Forefoot; Ankle

Introduction/Purpose:

Lisfranc(LF) injuries are challenging to diagnose due to the subtlety of instability and low diagnostic sensitivity of traditional imaging methods like MRI and CT. These modalities fall short in accurately identifying subtle LF injuries because they do not simulate physiological load or provide sufficient bone detail under non-weightbearing conditions. Weightbearing computed tomography (WBCT) has emerged as a superior diagnostic technique, leveraging load-bearing conditions and superior bony visualization to detect subtle joint instabilities that other methods miss. This systematic review advances previous findings by comparing WBCT to conventional CT in diagnosing LF injury, as well as the ability to detect LF injuries of differing severity.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this study. The PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases were searched from database inception until July 5th, 2023. The search algorithm utilized keywords that pertained to computed tomography and tarsometatarsal to find relevant articles. Eligibility criteria included articles using CT or WBCT. Articles were then retrieved, duplicates removed, and screening conducted based on article title, abstract, and full text using inclusion and exclusion criteria. Data extraction included author, publication year, patient demographic, injury description, imaging modality used, measurements, and p values. Articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale, and statistical analysis of the extracted data conducted.

Results:

Out of the 498 articles retrieved, 9 met inclusion criteria. Several studies reported that WBCT was able to provide a higher level of accuracy than conventional CT when measuring the Lisfranc area, with enhanced sensitivity to subtle alterations in joint structure. WBCT also demonstrated superior sensitivity when it came to distinguishing between healthy and injured Lisfranc joint, especially when it came to identifying dorsal ligament damage. WBCT was able to detect significant variation in important measurements such as the first-second (M1-M2) distance, the first cuneiform (C1)-M2 distance, and joint volumes. WBCT also demonstrated good intra- and inter-observer reliability. This enables a more comprehensive assessment of the Lisfranc joint health, especially when it came to cases of subtle joint instability.

Conclusion:

This systematic review demonstrates the value of WBCT over conventional CT when it comes to diagnosing LF injury. Not only was WBCT able to detect deviations in asymmetry and LF area that conventional CT was unable to identify, but it detected instability in cases of subtle injury, and was able to differentiate between injury groups at various lower levels of injury. This review is the first to include comparisons of objective image modalities, as well as Lisfranc injuries of various severities.