Description
Purpose
This research aims to scrutinize and amalgamate the prevailing radiographic diagnostic criteria for Lisfranc injuries, with an intention to propose a unified set of standards that could enhance diagnostic precision and ameliorate patient outcomes.
Methods
Adhering to the PRISMA guidelines, an exhaustive systematic review was undertaken utilizing the PubMed and Embase databases. The review entailed the collection and scrutiny of various radiographic criteria presently utilized in the diagnosis of Lisfranc injuries. The analysis incorporated continuous variables, delineated as mean ± standard deviation, and categorical variables, depicted as frequencies and percentages.
Results
The extensive literature search highlighted 29 pertinent studies, encompassing 1115 documented Lisfranc injuries. These studies were assessed for bias risk using the ROBINS-I tool, categorizing them as either "Low" or "Moderate," and the recommendations were graded from "Very Low" to "High" based on GRADE evaluations. Predominantly, the diagnostic criteria were focused on two elements: the 1st metatarsal to 2nd metatarsal diastasis (observed in 18 studies) and the 2nd cuneiform to 2nd metatarsal subluxation (noted in 11 studies). Nonetheless, a significant void was noted in standardization, particularly pertaining to the utilization or avoidance of load during imaging, and discrepancies in adopting absolute values on the affected side or a comparative analysis with the unaffected side.
Conclusion
The current radiographic diagnostic criteria for Lisfranc injuries exhibit considerable heterogeneity, potentially leading to diagnostic discrepancies. This research advocates for a more harmonized set of criteria, emphasizing the identification of either a 1st metatarsal to 2nd metatarsal diastasis on the anteroposterior view or a 2nd cuneiform to 2nd metatarsal subluxation on anteroposterior or oblique views as primary diagnostic indicators. In cases where radiographs fail to delineate these injuries conclusively yet a high clinical suspicion persists, the implementation of advanced imaging techniques, such as CT or MRI, is recommended to prevent misdiagnosis and facilitate optimal patient management.
