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
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