1
|
Seow D, Yasui Y, Chan LYT, Murray G, Kubo M, Nei M, Matsui K, Kawano H, Miyamoto W. Inconsistent radiographic diagnostic criteria for lisfranc injuries: a systematic review. BMC Musculoskelet Disord 2023; 24:915. [PMID: 38012651 PMCID: PMC10680278 DOI: 10.1186/s12891-023-07043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries. METHODS A systematic review of the PubMed and Embase databases was performed according to the PRISMA guidelines. The various radiographic criteria for the diagnosis of Lisfranc injuries were extracted. Descriptive statistics were presented for all continuous (as mean ± standard deviation) and categorical variables (as frequencies by percentages). RESULTS The literature search included 29 studies that totalled 1115 Lisfranc injuries. The risk of bias ranged from "Low" to "Moderate" risk according to the ROBINS-I tool. The overall recommendations according to the GRADE assessment ranged from "Very Low" to "High". 1st metatarsal to 2nd metatarsal diastasis was the most common of the 12 various radiographic diagnostic criteria observed, as was employed in 18 studies. This was followed by 2nd cuneiform to 2nd metatarsal subluxation, as was employed in 11 studies. CONCLUSION The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. The proposition for homogenous radiographic diagnostic criteria is that the following features must be observed for the diagnosis of Lisfranc injuries: 1st metatarsal to 2nd metatarsal diastasis of ≥ 2 mm on anteroposterior view or 2nd cuneiform to 2nd metatarsal subluxation on anteroposterior or oblique views. Further advanced imaging by CT or MRI may be required in patients with normal radiographs but with continued suspicion for Lisfranc injuries. LEVEL OF EVIDENCE 4, systematic review.
Collapse
Affiliation(s)
- Dexter Seow
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Youichi Yasui
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Li Yi Tammy Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gareth Murray
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maya Kubo
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Masashi Nei
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| |
Collapse
|
2
|
Ashkani-Esfahani S, Mojahed-Yazdi R, Bhimani R, Kerkhoffs GM, Maas M, DiGiovanni CW, Lubberts B, Guss D. Deep Learning Algorithms Improve the Detection of Subtle Lisfranc Malalignments on Weightbearing Radiographs. Foot Ankle Int 2022; 43:1118-1126. [PMID: 35590472 DOI: 10.1177/10711007221093574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Detection of Lisfranc malalignment leading to the instability of the joint, particularly in subtle cases, has been a concern for foot and ankle care providers. X-ray radiographs are the mainstay in the diagnosis of these injuries; thus, improving the performance of clinicians in interpreting radiographs can noticeably affect the quality of health care in these patients. Here we assessed the performance of deep learning algorithms on weightbearing radiographs for detection of Lisfranc joint malalignment in patients with Lisfranc instability. METHODS In a retrospective study, 640 patients with Lisfranc malalignment leading to instability were recruited plus 640 individuals with uninjured feet and healthy Lisfranc joint as the control group. All radiographs were screened by orthopaedic surgeons. Two deep learning models were trained, validated, and tested (in a ratio 80:10:10) using a single-view (anteroposterior) and 3-view (anteroposterior, lateral, oblique) radiographs. The performances of the models were reported as sensitivity, specificity, positive and negative predictive values, accuracy, F score, and area under the curve (AUC). RESULTS No significant differences were observed between the patients and the controls regarding age, gender, race, and body mass index. The best deep learning algorithm outperformed our human interpreters (<1% vs ~10% misdiagnosis), 94.8% sensitivity, 96.9% specificity, 98.6% accuracy, 95.8% F score, and 99.4% AUC. CONCLUSION Deep learning methods have shown promising potential in acting as an assistant interpreter of radiographic images in patients with Lisfranc malalignment. Developing these algorithms can hasten and improve the accuracy of diagnosis and reduce further costs and burdens on the patients and health care system. LEVEL OF EVIDENCE Level III, case-control Machine Learning study.
Collapse
Affiliation(s)
- Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Reza Mojahed-Yazdi
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Rohan Bhimani
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Gino M Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Bart Lubberts
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| |
Collapse
|
3
|
Reliability of various diastasis measurement methods on weightbearing radiographs in patients with subtle Lisfranc injuries. Skeletal Radiol 2022; 51:801-806. [PMID: 34410434 DOI: 10.1007/s00256-021-03892-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the reliability of the diastasis measurements between the medial cuneiform and the second metatarsal on weightbearing radiography. MATERIALS AND METHODS We retrospectively examined 18 patients who underwent open surgery for subtle Lisfranc injuries. Preoperative weightbearing radiography of the affected and unaffected feet was evaluated in all patients. The diastasis between the medial cuneiform and the second metatarsal was measured in both feet using the following four methods: diastasis between parallel lines, distal point diastasis, middle point diastasis, and proximal point diastasis. Intraclass correlation coefficients with consistency of agreement were calculated to evaluate inter- and intraobserver reliability. RESULTS The intra- and interobserver reliabilities of all four methods were good. Intraclass correlation coefficients for intraobserver reliability ranged from 0.87 to 0.93. Those for interobserver reliability ranged from 0.81 to 0.91. CONCLUSIONS The reliabilities of the diastasis measurement methods between the medial cuneiform and the second metatarsal on weightbearing radiography were good. Measuring the diastasis between the medial cuneiform and the second metatarsal on weightbearing radiography is useful in evaluating subtle injuries when uniform measurement methods are used.
Collapse
|