Ligamentous restraints of the second tarsometatarsal joint:​ a biomechanical evaluation

Solan, Matthew C.<sup>1</sup>; Moorman, III, Claude T.<sup>1</sup>; Miyamoto, Ryan G.<sup>1</sup>; Jasper, Louis E.<sup>1</sup>; Belkoff, Stephen M.<sup>1</sup>

Affiliations

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD

Abstract and keywords

Ligamentous injury of the tarsometatarsal joint complex is an uncommon, but disabling condition that frequently occurs in elite athletes. There are few options for managing these injuries, in part because the relative mechanical contribution of the ligaments of the tarsometatarsal joint is unknown, complicating decisions regarding which ligaments need reconstruction. In the current study, strength and stiffness of the dorsal, plantar, and Lisfranc ligaments of 20 paired cadaver feet were measured and compared. The plantar and Lisfranc ligaments were significantly stiffer and stronger than the dorsal ligament, and the Lisfranc ligament was significantly stronger and stiffer than the plantar ligament.

Keywords: Lisfranc Joint; Ligament; Anatomy; Biomechanics; Cadaver

Links

DOI: 10.1177/107110070102200804

PubMed: 11527024

WoS: 000170640300004

Cited Works (17)

Year	Entry
1998	Burroughs KE, Reimer CD, Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58(1):118-124.
1997	de Palma L, Santucci A, Sabetta SP, Rapali S. Anatomy of the Lisfranc joint complex. Foot Ankle Int. June 1997;18(6):356-364.
1999	Davies MS, Saxby TS. Intercuneiform instability and the "gap" sign. Foot Ankle Int. September 1999;20(9):606-609.
1995	Groshar D, Alperson M, Mendes DG, Barsky V, Liberson A. Bone scintigraphy findings in Lisfranc joint injury. Foot Ankle Int. November 1995;16(11):710-711.
1996	Ross G, Cronin R, Hauzenblas J, Juliano P. Plantar ecchymosis sign: a clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries. J Orthop Trauma. 1996;10(2):119-122.
1993	Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia: J. B. Lippincott Company; 1993.
1996	O'Malley MJ, Hamilton WG, Munyak J. Fractures of the distal shaft of the fifth metatarsal: "dancer's fracture". Am J Sports Med. 1996;24(2):240-243.
1999	Preidler KW, Peicha G, Lajtai G, Seibert FJ, Fock C, Szolar DM, Raith H. Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. Am J Roentgen. 1999;173(6):1673-1677.
1996	Preidler KW, Wang Y-c, Brossmann J, Trudell D, Daenen B, Resnick D. Tarsometatarsal joint: anatomic details on MR images. Radiology. 1996;199(3):733-736.
1994	Shapiro MS, Wascher DC, Finerman GAM. Rupture of Lisfranc's ligament in athletes. Am J Sports Med. September–October 1994;22(5):687-691.
1998	Coss HS, Manos RE, Buoncristiani A, Mills WJ. Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. Foot Ankle Int. 1998;19(8):537-541.
1981	Norfray JF, Geline RA, I.Steinberg R, Galinski AW, Gilula LA. Subtleties of Lisfranc fracture-dislocations. Am J Roentgen. 1981;137(6):1151-156.
1996	Preidler KW, Brossman J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients. Am J Roentgen. 1996;167(5):1217-1222.
1994	Mantas JP, Burks RT. Lisfranc injuries in the athlete. Clin Sports Med. 1994;13(4):719-730.
1998	>Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int. July 1998;19(7):438-446.
1993	Curtis MJ, Myerson M, Szura B. Tarsometatarsal joint injuries in the athlete. Am J Sports Med. July 1993;21(4):497-502.
1990	Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg. December 1990;72A(10):1519-1522.

Cited By (52)

Year	Entry
2014	Anderson JG, Bohay DR, Patthanacharoenphon CG, Ertl AM. Midfoot injuries. In: Philbin TM, ed. Sports Injuries of the Foot: Evolving Diagnosis and Treatment. New York, NY: Springer; 2014:71-86.
2007	Aronow MS. Ligamentous Lisfranc joint injuries: leg/ankle/foot: midfoot injuries, lisfranc. In: Johnson DH, Pedowitz RA, eds. Practical Orthopaedic Sports Medicine and Arthroscopy. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:907-914.
2006	Esway J-E, Boyer M, Shereff M, Wukich DK. Lisfranc injuries: what have we learned since Napoleon’s era? Operative Tech Orthop. 2006;16(1):60-67.
2015	Salzar RS, Lievers WB, Bailey AM, Crandall JR. Leg, foot, and ankle injury biomechanics. In: Yoganandan N, Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 3rd ed. New York: Springer; 2015:499-547.
2006	Walther M, Zdrazil U, Stäbler A. Mittelfuß-Distorsionen im Sport [Midfoot sprains in sports]. Fuß & Sprunggelenk. 2006;4(3):166-173.
2012	Frimenko RE, Lievers WB, Riley PO, Crandall JR, Kent RW. A method to induce navicular‐cuneiform/cuneiform‐first metatarsal sprain in athletes. In: Proceedings of the 2012 International IRCOBI Conference on the Biomechanics of Injury. September 12-14, 2012; Dublin, Ireland.265-276.
2006	Hunt SA, Ropiak C, Tejwani NC. Lisfranc joint injuries: diagnosis and treatment. Am J Orthop (Belle Meade, NJ). August 2006;35(8):376-385.
2010	Castro M, Melão L, Canella C, Weber M, Negrão P, Trudell D, Resnick D. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. Am J Roentgen. 2010;195(6):W447-W455.
2016	Deol RS, Roche A, Calder JDF. Return to training and playing after acute Lisfranc injuries in elite professional soccer and rugby players. Am J Sports Med. January 2016;44(1):166-170.
2012	Shin J, Yue N, Untaroiu CD. A finite element model of the foot and ankle for automotive impact applications. Ann Biomed Eng. December 2012;40(12):2519-2531.
2017	Smolen C, Quenneville CE. A finite element model of the foot/ankle to evaluate injury risk in various postures. Ann Biomed Eng. August 2017;45(8):1993-2008.
2006	Grivas TB, Vasiliadis ED, Koufopoulos G, Polyzois VD, Polyzois DG. Midfoot fractures. Clin Podiatr Med Surg. 2006;23(2):323-341.
2010	Chaney DM. The Lisfranc joint. Clin Podiatr Med Surg. October 2010;27(4):547-560.
2004	Mullen JE, O'Malley MJ. Sprains—residual instability of subtalar, Lisfranc joints, and turf toe. Clin Sports Med. 2004;23:97-121.
2006	Scot E. Campbell M. MRI of sports injuries of the ankle. Clin Sports Med. October 2006;25(4):15-23.
2014	Matar HE, Atkinson HD, Toh EM, Akimau PI, Davies MB. Surgical interventions for treating tarsometatarsal (Lisfranc) fracture dislocations. Cochrane Database Sys Rev. 2014;(7):CD011235.
2015	Lievers WB, Frimenko RE, McCullough KA, Crandall JR, Kent RW. Etiology and biomechanics of midfoot (Lisfranc) injuries in athletes. Crit Rev Biomed Eng. 2015;43(2-3):213-238.
2005	Briggs PJ. The structure and function of the foot in relation to injury. Curr Orthop. 2005;19(2):85-93.
2005	Makwana NK. Tarsometatarsal injuries—Lisfranc injuries. Curr Orthop. 2005;19(2):108-118.
2006	Aronow MS. Treatment of the missed lisfranc injury. Foot and Ankle Clinics. 2006;11(1):127-142.
2009	DeOrio M, Erickson M, Usuelli FG, Easley M. Lisfranc injuries in sport. Foot and Ankle Clinics. June 2009;14(2):169-186.
2013	Eleftheriou KI, Rosenfeld PF. Lisfranc injury in the athlete: evidence supporting management from sprain to fracture dislocation. Foot and Ankle Clinics. June 2013;18(2):219-236.
2005	Kadel N, Boenisch M, Tietz C, Trepman E. Stability of Lisfranc joint in ballet pointe position. Foot Ankle Int. May 2005;26(5):394-400.
2005	Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ. Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int. 2005;26(6):462-473.
2013	Panchbhavi VK, Molina D IV, Villarreal J, Curry MC, Andersen CR. Three-dimensional, digital, and gross anatomy of the Lisfranc ligament. Foot Ankle Int. June 2013;34(6):876-880.
2014	O’Neill BJ, Sweeney LA, Moroney PJ, Mulhall KJ. Atypical stress-avulsion fracture of the Lisfranc joint complex. Foot Ankle Spec. April 2014;7(2):155-158.
2013	Marsland D, Belkoff SM, Solan MC. Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning. Foot Ankle Surg. December 2013;19(4):267-272.
2010	Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg. December 2010;18(12):718-728.
2004	Fauth AR, Hamel AJ, Sharkey NA. In vitro measurements of first and second tarsometatarsal joint stiffness. J Appl Biomech. 2004;20(1):14-24.
2021	Sripanich Y, Steadman J, Krähenbühl N, Rungprai C, Saltzman CL, Lenz AL, Barg A. Anatomy and biomechanics of the Lisfranc ligamentous complex: a systematic literature review. J Biomech. April 15, 2021;119:110287.
2017	Shakked RJ. Lisfranc injury in the athlete. JBJS Reviews. September 2017;5(9):e4.
2007	Kaar S, Femino J, Morag Y. Lisfranc joint displacement following sequential ligament sectioning. J Bone Joint Surg. 2007;89A(10):2225-2232.
2008	Myerson MS, Cerrato RA. Current management of tarsometatarsal injuries in the athlete. J Bone Joint Surg. 2008;90A(11):2522-2533.
2008	Panchbhavi VK, Andersen CR, Vallurupalli S, Yang J. A minimally disruptive model and three-dimensional evaluation of Lisfranc joint diastasis. J Bone Joint Surg. 2008;90A(12):2707-2713.
2009	Panchbhavi VK, Vallurupalli S, Yang J, Andersen CR. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg. 2009;91A(5):1143-1148.
2022	Requist MR, Sripanich Y, Rolvien T, Lenz AL, Barg A. Micro-CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions. J Orthop Res. June 2022;40(6):1457-1469.
2022	Malakoutikhah H, Madenci E, Latt LD. The contribution of the ligaments in progressive collapsing foot deformity: a comprehensive computational study. J Orthop Res. September 2022;40(9):2209-2221.
2023	Malakoutikhah H, Madenci E, Latt LD. A computational model of force within the ligaments and tendons in progressive collapsing foot deformity. J Orthop Res. February 2023;41(2):396-406.
2013	Hirano T, Niki H, Beppu M. Anatomical considerations for reconstruction of the Lisfranc ligament. J Orthop Sci. September 2013;18(5):720-726.
2010	Pearce CJ, Calder JD. Surgical anatomy of the midfoot. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):581-586.
2013	Eleftheriou KI, Rosenfeld PF, Calder JDF. Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc. June 2013;21(6):1434-1446.
2008	Crim J. MR imaging evaluation of subtle lisfranc injuries: the midfoot sprain. Mag Reson Imaging Clin N Am. 2008;16(1):19-27.
2016	Mangin M, Seivert V, Galliot F, Lefevre M, Piessat C, Gross J-B, Delagoutte J-P, Coudane H. Résultats des arthrorises entre le deuxième métatarsien et le cunéiforme médial dans les luxations tarsométatarsiennes: à propos de 15 cas à un recul de cinq ans [Outcome after arthrorisis of the second metatarsal’s base with the medial cuneiform after tarsometatarsal dislocations: about 15 patients in 5 years]. Méd Chir Pied. June 2016;32(2):54-60.
2021	Simonik MM, Pitarresi JM, Willing R. Development of customized finite element models of medial column fixation using an intramedullary beam: a computational sensitivity analysis. Med Eng Phys. February 2021;88:32-40.
2011	Rosenbaum A, Dellenbaugh S, DiPreta J, Uhl R. Subtle injuries to the Lisfranc joint. Orthopedics. November 2011;34(11):882-887.
2010	Granata JD, Philbin TM. The midfoot sprain: a review of Lisfranc ligament injuries. Phys Sportsmed. December 2010;38(4):119-126.
2014	Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. RadioGraphics. March–April 2014;34(2):514-531.
2008	Hatem SF. Imaging of Lisfranc injury and midfoot sprain. Radiol Clin North Am. 2008;46(6):1045-1060.
2019	Haraguchi N, Ota K, Ozeki T, Nishizaka S. Anatomical pathology of subtle Lisfranc injury. Sci Rep. October 16, 2019;9:14831.
2003	Sammarco VJ. Principles and techniques in rehabilitation of the athlete's foot, IV: rehabilitation of static joints. Tech Foot Ankle Surg. 2003;2(4):272-279.
2015	Smolen C. Evaluation of the Load Path Through the Foot/ankle Complex in Various Postures Through Cadaveric and Finite Element Model Testing [Master's thesis]. Hamilton, ON: McMaster University; September 2015.
2011	Shin J. Injury and Response of Human Ankle and Subtalar Joints Under Complex Loading [PhD thesis]. Charlottesville, VA: University of Virginia; December 2011.