Revista de Medicina Desportiva (English) March 2018 - Page 25

Revista Medicina Desportiva informa, 2018; 9(2):23-25. Lisfranc Injuries in Athletes Dr. Luís Duarte Silva 1,2 , Dr. Bruno Pereira 1,2 , Dr. Renato Andrade 1-3 , Dr. Ricardo Bastos 1,2,4 , Prof. Doutor João Espregueira-Mendes 1,2,5-7 1 Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto; 2 Dom Henrique Research Centre; 3 Faculdade de Desporto da Universidade do Porto; 4 Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brasil; 5 Grupo de Investigação 3B’s – Biomateriais, Biodegradáveis e Biomiméticos. Universidade do Minho – Guimarães; 6 Laboratório Associado ICVS/3B’s, Braga/Guimarães; 7 Departamento de Ortopedia da Unive rsidade do Minho, Braga. ABSTRACT Lisfranc injuries are many times neglected and severe consequences can be expected in the athlete. For this reason, the physician must have an elevated degree of suspicion. The diagnosis may require several image methods including x-ray, computed tomography and magnetic resonance. The treat- ment may be conservative or surgical depending on the presence or not of instability and/or dis- placed injuries. The conservative treatment involves firstly non-weight-bearing and immobilization on the affected limb. The surgical treatment can involve an osteosynthesis with plate and screws or just screws, or even a suture button fixation. Another alternative is the primary arthrodesis who- ever the results among athletes are still controversial and not recommended. KEYWORDS Lisfranc injury, Athletes, Foot Anatomy Lisfranc lesions present peculiari- ties that require special attention on behalf of the health profession- als who deal with its diagnosis and treatment, especially in the athlete population, since diagnostic error in this pathology can have devastat- ing consequences on the athlete’s career, possibly leading to deformity, instability and degenerative altera- tions. 1 It is important to note that lesions in athletes present different characteristics from the lesions tra- ditionally described in the literature, since the latter are mostly correlated with high energy traumas, noting that frequently in the athletic popu- lation, the lesion is usually purely ligamentous and subtle. Figure 1 – The Lisfranc joint http://clinicaecirurgiadope.com.br/ckfinder/images/ Lisfranc600.png Structurally, the foot is divided into three longitudinal anatomical columns: medial, intermediate and lateral: 2,3 • the medial column is composed of the medial cuneiform and first metatarsal • the intermediate column is formed by the second and third metatarsals and the intermediate and lateral cuneiform • the lateral column is composed of the cuboid and the fourth and fifth metatarsals. The navicular bone intersects the medial and intermediate column. The Lisfranc, or tarsometatarsal, joint (Figure 1) consists of the distal row of the tarsal bones and the five metatarsal bases. The second metatarsal bone, inlaid proximally, serves as a cornerstone for this joint. Stability is also provided by the tarsometatarsal and intermetatarsal ligaments. The Lisfranc ligament is a connection that originates from the lateral region of the medial cuneiform bone and extends to the medial region of the base of the sec- ond metatarsal, being crucial in sta- bilizing the tarsometatarsal joint. 4 The Lisfranc injury, also known as Lisfranc fracture, was first described by the French surgeon Jacques Lis- franc de St Martin (1790-1847), who also described the amputation in this region. 5 This lesion frequently occurred in knights on the bat- tlefield after falling from their horse (Figure 2). The terminology of Lisfranc lesion involves a broad spectrum of lesions, ranging from a merely ligamentous injury up to an injury with bone involvement, the latter representing 0.2% of all frac- tures (Figure 3). 5,6 Several mecha- nisms of injury exist, however it is commonly described in the litera- ture as a forced plantar flexion and/ or abduction with the foot in contact with the ground in an equinus posi- tion as being the most common. 7 The Quenu and Kuss classification has been utilized since it was first described at the beginning of the 20th century, being divided into 3 types: homolateral, isolated and divergent. More recently, Nunley and Vertullo developed a classification considering the sports population and based on weight-bearing X-ray. This classifica- tion is comprised of three types: 8,9 • type 1 – the athlete who can bear weight but has no capacity to practice sports and no changes are seen in the X-ray Revista de Medicina Desportiva informa march 2018 · 23