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Anatomy of the Lisfranc Ligament

Keith Hill, MD

John Ward, PhD

James Ficke, MD

Most authors agree that anatomic reduction is the key to optimal results in treatment of injuries of the Lisfranc joint; a few controversies remain. One controversy is the identification of the strongest ligament of the second metatarsal-medial cuneiform articulation—the critical ligament of the Lisfranc joint. The purpose of this study is to objectively quantify the cross-sectional area of each ligament of this crucial joint. Twenty cadaveric feet were dissected to isolate the second metatarsal-medial cuneiform articulation. The point of maximum thickness, height, and width of the dorsal, plantar, and interosseous ligaments were measured using handheld calipers at the second metatarsal attachment. The distribution failed to pass Mauchly's test of sphericity, so the Greenhouse-Geisser method was used to assess differences in the height and width to a P .05 level of significance. There was a significant difference in the height, width, and area between all ligaments (P < .001). The interosseous ligament was the largest, with the greatest height, width, and cross-sectional area (P < .001). The dorsal ligament was the smallest, with the least height, width, and cross-sectional area (P < .001). Within the Lisfranc complex, the dorsal ligament is the smallest. The plantar ligament is twice as large as the dorsal ligament. The interosseous ligament is the largest. It is, on average, 4.5 times larger than the dorsal ligament and twice as large as the plantar ligament.

Key Words: Lisfranc • tarso-metatarsal • ligament

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