Return-to-sport following Operative Management of Lisfranc Injuries in Competitive Athletes

Abstract

Category: Sports; Midfoot/Forefoot Introduction/Purpose: The relative incidence of Lisfranc injuries amongst competitive athletes is higher than the incidence in the general population. Lisfranc injuries can be particularly devastating to competitive athletes. They can dramatically hinder athletic performance, cause severe midfoot pain, and are difficult to diagnose. It is well documented that many Lisfranc injuries are initially misdiagnosed. To date, there is limited literature surrounding return-to-sport timelines and outcomes following operatively managed Lisfranc injuries in competitive athletes. The purpose of this study is to present an average return-to-sport timeline and patient-reported outcomes of surgically treated Lisfranc injuries in competitive athletes. Methods: Patients with surgically treated Lisfranc injuries by a single surgeon between May 2012 and February 2022 were identified through retrospective chart review. Competitive athletes and their levels of athletic competition were identified through clinical and surgical documentation. Patients with surgically treated Lisfranc injuries that were not active competitive athletes at the time of injury were excluded. Data from a novel Lisfranc return-to-sport survey was prospectively collected. Patient-reported outcome measures (PROMs) analyzed included the visual analog scale (VAS) pain scale, Veterans RAND 12-Item Health Survey (VR-12), and the Foot and Ankle Ability Measure (FAAM). PROMs with latest follow-up less than 12 months from the date of surgery were excluded from analysis. The differences between mean preoperative and mean latest follow-up outcome measures were analyzed using simple t tests with significance set at P<.05. Results: Forty-six competitive athletes were surgically treated for Lisfranc injuries. All PROMs demonstrated statistically significant improvement upon latest follow-up except for the VR-12 Mental (Table 1). Nine patients (9/46) were lost to follow-up. Thirty- two patients (86.5%, 32/37) completed the Lisfranc return-to-sport survey at a mean follow-up time of 52.17 (range, 7.33-125.26) months after surgery. Twenty-eight patients (28/32) desired to return to play, and four did not (4/32). Twenty-seven patients (96.4%, 27/28) successfully returned to sport after an average of 5.5 (range, 3-12) months. Twenty-two patients (22/28) eventually returned to pre-injury levels of play, and six (6/28) did not. Average pain levels when returning to play were 26.2/100. Twenty- three patients (23/28) were eventually able to play pain free. Overall average patient satisfaction level was 95.6/100. Conclusion: This study is one of the largest known cohorts (n=46) of competitive athletes with operatively managed Lisfranc injuries to have return-to-sport time and PROMs analyzed. Overall, the return-to-sport rate, PROMs, and patient satisfaction levels were excellent for this cohort. Of the athletes who desired to return-to-sport, the return-to-sport rate was 96.4% with a mean return-to-sport time of 5.5 (range, 3-12) months after surgery. All PROMs (VAS, VR-12 Physical, FAAM) except for the VR- 12 Mental demonstrated statistically significant improvement at latest follow-up.