Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons · 2025
Advancing diagnostics: A systematic review and meta-analysis of conventional and weight-bearing CT in lisfranc injuries.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Gómez Alejandro Lorente, Cuenca Marcela Gómez, Moreno Carmen Victoria Rojas, Cabezas Pablo Palacios, Mariscal Gonzalo, Khalil Ibrahim, Moreno Rafael Lorente, Berdullas Leire Pelaz
Аннотация
OBJECTIVE: This systematic review and meta-analysis evaluated the diagnostic accuracy of conventional computed tomography (CT) and weight-bearing computed tomography (WBCT) in assessing Lisfranc injuries, comparing their sensitivity, specificity, and reliability for detecting structural abnormalities between injured and uninjured cases.
METHODS: A systematic search of PubMed, Scopus, WOS, and Medline databases identified 736 articles, of which 16 studies met the inclusion criteria. Seven studies were included in the meta-analysis. The analysis examined measurements such as M1-M2 and M2-C1 base distances, TMT1 and TMT2 dorsal step-offs, axial joint area and volume, and alignment parameters. Subgroup analyses compared conventional CT and WBCT methods.
RESULTS: The injured group showed significantly greater M1-M2 and M2-C1 Base Distances than the uninjured group (M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm; p-value < 0.0001), with no significant differences between imaging modalities. The injured group had greater TMT2 dorsal step-offs (MD = 0.81 mm; p < 0.001), while TMT1 dorsal step-off differences varied between modalities. Injured joints demonstrated significantly larger Axial Joint Area and Volume (MD = 16.26 mm²) and volumes (MD = 189.1 mm³; p < 0.0001). Additionally, WBCT demonstrated high sensitivity and specificity for Lisfranc injuries, particularly for parameters like axial joint volume (AUC = 0.91). Conventional CT showed variable diagnostic performance, with sensitivity and specificity ranging from 69 % to 97.9 % and 39.3-100 %, respectively. The "Mercedes sign" (a three-pointed star appearance on axial CT indicating C1-M2 diastasis) and "Peeking cuneiform sign" (visible medial cuneiform between first and second metatarsals on AP view) showed over 92 % sensitivity and specificity.
CONCLUSIONS: Both conventional CT and WBCT effectively identify Lisfranc injuries when comparing injured and uninjured cases, with WBCT demonstrating superior sensitivity, specificity, and diagnostic accuracy in certain parameters. Conventional CT remains reliable but exhibits variability in specific assessments. Future research should focus on standardizing imaging protocols and refining diagnostic thresholds to enhance consistency and accuracy.
METHODS: A systematic search of PubMed, Scopus, WOS, and Medline databases identified 736 articles, of which 16 studies met the inclusion criteria. Seven studies were included in the meta-analysis. The analysis examined measurements such as M1-M2 and M2-C1 base distances, TMT1 and TMT2 dorsal step-offs, axial joint area and volume, and alignment parameters. Subgroup analyses compared conventional CT and WBCT methods.
RESULTS: The injured group showed significantly greater M1-M2 and M2-C1 Base Distances than the uninjured group (M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm; p-value < 0.0001), with no significant differences between imaging modalities. The injured group had greater TMT2 dorsal step-offs (MD = 0.81 mm; p < 0.001), while TMT1 dorsal step-off differences varied between modalities. Injured joints demonstrated significantly larger Axial Joint Area and Volume (MD = 16.26 mm²) and volumes (MD = 189.1 mm³; p < 0.0001). Additionally, WBCT demonstrated high sensitivity and specificity for Lisfranc injuries, particularly for parameters like axial joint volume (AUC = 0.91). Conventional CT showed variable diagnostic performance, with sensitivity and specificity ranging from 69 % to 97.9 % and 39.3-100 %, respectively. The "Mercedes sign" (a three-pointed star appearance on axial CT indicating C1-M2 diastasis) and "Peeking cuneiform sign" (visible medial cuneiform between first and second metatarsals on AP view) showed over 92 % sensitivity and specificity.
CONCLUSIONS: Both conventional CT and WBCT effectively identify Lisfranc injuries when comparing injured and uninjured cases, with WBCT demonstrating superior sensitivity, specificity, and diagnostic accuracy in certain parameters. Conventional CT remains reliable but exhibits variability in specific assessments. Future research should focus on standardizing imaging protocols and refining diagnostic thresholds to enhance consistency and accuracy.