Mittelfuß-Distorsionen im Sport

Abstract

Summary Midfoot sprains present with a wide spectrum of injuries of the Lisfranc ligament complex. The injury can be classified into sprains, partial ruptures and complete ruptures of the Lisfranc ligament complex. Weight bearing dorsoplantar X-rays are mandatory to demonstrate the diastases between the base of the first and second meta-tarsal. In complete ruptures, the longitudinal arch flattens in eightbearing lateral X-rays. MRI can show in detail the ligament rupture, additional microfractures and minor displacement of the Lisfranc joint line. Nonoperative management is suggested for stage I injuries, whereas early ORIF is recommended for stage II and III injuries. We have treated 12 patients with Lisfranc ligament injuries within the last 5 years. Five patients with stage I injuries were treated conservatively; 7 patients with stage II and III injuries underwent ORIF. One case with delayed diagnoses was treated with an arthrodesis of the first TMT joint due to severe degenerative arthritis. All patients with grade I injuries returned to sports without limitations. In 2 of the 4 patients with stage III injuries no limitations in doing sports are reported; however in high intensity performance they feel some restrictions. Early restoration and maintenance of the anatomic alignment of the Lisfranc ligament complex seems to be the key to good clinical results. A delay in diagnosis and treatment seems to increase the risk for limitations in performance in sports.