The Epidemiology of Lisfranc Injuries at the NFL Combine

Abstract

Category: Sports Introduction/Purpose: Lisfranc injuries can have detrimental consequences to an athlete’s career. If left inadequately treated, these injuries can result in persistent pain and lead to advanced osteoarthritis. Understanding the prevalence of these injuries in collegiate athletes and their effect on NFL draft position can help team physicians counsel future players and determine optimal treatment. The purpose of this study was to determine the epidemiology of Lisfranc injuries in players participating in the NFL combine and to determine the positions that are at higher risk for sustaining these injuries. Methods: Data was collected from the NFL combine website on all players who participated in the combine and had sustained a Lisfranc injury before entering the NFL from 2009 to 2015. Medical records, imaging, and treatments were reviewed on players who were identified with these injuries. The epidemiology of Lisfranc injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Odds ratios were calculated using logistic regression to assess the risk of sustaining each injury by position. Two-sample, two-tailed T-tests were computed to assess games missed and draft position in players with operative versus non-operative management. Players with a Lisfranc injury as well a second primary midfoot injury (n=3) were excluded from analysis. Results: Thirty-nine(1.7%) players at the NFL combine had an isolated Lisfranc injury during their collegiate football career. Of these players, 27(69.2%) required surgical intervention. The average number of collegiate football games missed for this injury was 3.0±5.0. The average number of games missed for players requiring operative fixation was statistically greater(4.2±5.7) than those in the non-operative group (0.3 ±0.9, p=0.02). The average NFL draft position was 141.7±69.4, and 13(33.3%) went undrafted. There was no statistical difference in the average draft position(p=0.84) and number of undrafted players(p=0.15) between the operative and non-operative groups. No position was found to be at increased risk for Lisfranc injury; however, as a whole, offensive players had a significantly increased risk(Odds ratio=2.7, p = 0.01) of having a Lisfranc injury when compared to all other players. Overall, 24(61.5%) of the players with a Lisfranc injury played on offense. Conclusion: The majority of players who reported a Lisfranc injury required operative intervention, and offensive players were at a higher risk for this injury. Lisfranc requiring operative management did not significantly change a player’s draft position or chance of being drafted.