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Anatomie et imagerie de l’articulation tarsométatarsienne (articulation de Lisfranc)

Anatomy and imaging of the tarsometatarsal joint (Lisfranc joint)

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Médecine et Chirurgie du Pied

Résumé

L’articulation tarsométatarsienne (articulation de Lisfranc) unit les cinq métatarsiens au tarse antérieur (os cunéiforme médial, intermédiaire et latéral, et cuboïde). Articulation synoviale, constituée de trois compartiments à surface plane, elle est caractérisée par sa stabilité, conditionnée par son interligne en ligne brisée, liée à la disposition en mortaise de la base de M2 et des trois cunéiformes, et par l’importance de son système ligamentaire, comportant en particulier le ligament interosseux cunéométatarsien médial (ligament de Lisfranc). Sa pathologie est dominée par les lésions traumatiques qui s’observent lors d’accidents violents comportant notamment une flexion plantaire forcée. L’imagerie fait essentiellement appel aux radiographies standard, à la tomodensitométrie (TDM) et à l’imagerie par résonance magnétique nucléaire (IRM). La radiographie standard reste l’examen de première intention, mais le risque de méconnaissance ou de sous-estimation des lésions doit être souligné. Examen de référence de l’os minéralisé, grâce à sa résolution spatiale et ses reconstructions multiplanaires et tridimensionnelles, la TDM est la technique d’imagerie de choix dans la pathologie traumatique de l’articulation comportant le plus souvent des fractures multiples et des lésions associées. L’IRM apporte des informations plus précises pour les lésions ligamentaires et synoviales en particulier grâce à sa résolution en densité.

Abstract

The tarsometatarsal joint (Lisfranc joint) is a synovial articulation of plane variety that is made up of three compartments. It is located between the bases of the five metatarsals and the anterior tarsal bones (medial, intermediate, lateral cuneiforms and cuboid bones). A great stability is provided by the particular shape of the joint compared to a mortise created by the cuneiform bones and the base of the second metacarpal, sometimes referred to as the “keystone concept”, as well as strong dorsal, plantar and interosseous ligaments, including mainly the first medial cuneometatarsal interosseous ligament (Lisfranc ligament). Traumatic lesions are the commonest disorders of this joint. Violent accidents including a mechanism of forced plantar flexion combined with rotation are the main causes of injury. Imaging of the tarsometatarsal joint includes conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MR). Conventional radiographic projections remain the first-line imaging modality. However, owing to their often subtle radiographic presentation, Lisfranc lesions are frequently overlooked. Due to its excellent spatial resolution and three-dimensional imaging capabilities, CT is the procedure of choice for the evaluation of the injured foot. MR may be more accurate at detecting ligamentous and synovial disorders particularly owing to its high density resolution.

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Authors and Affiliations

  1. Service d’imagerie Guilloz, hôpital central, Département d’anatomie, Faculté de médecine, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO no 34, F-54035, Nancy cedex, France

    B. Grignon & G. Oldrini

  2. Service de chirurgie orthopédique et traumatologique, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, CO no 34, F-54035, Nancy cedex, France

    D. Mainard & L. Galois

Authors
  1. B. Grignon
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  2. D. Mainard
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  3. G. Oldrini
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  4. L. Galois
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Corresponding author

Correspondence to B. Grignon.

Additional information

Cet article a été présenté lors du congrès de la SFMCP en novembre 2010.

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Grignon, B., Mainard, D., Oldrini, G. et al. Anatomie et imagerie de l’articulation tarsométatarsienne (articulation de Lisfranc). Med Chir Pied 27, 82–88 (2011). https://doi.org/10.1007/s10243-011-0317-9

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  • DOI: https://doi.org/10.1007/s10243-011-0317-9

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