Outcomes of Lisfranc Injuries in the National Football League

Abstract

Objectives: Tarsometatarsal (Lisfranc) joint injuries commonly occur in American professional football competition; however, the career impact of these injuries is unknown. This study aims to define the time to return to competition for professional football players who sustained Lisfranc injuries and to quantify their effect on athletic performance. Methods: Data on National Football League (NFL) players who sustained a Lisfranc injury during a ten-year time period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) were collected for analysis. Recorded demographic variables included age, experience, position, and operative vs. non-operative management. Outcomes data collected for offensive players (running backs, wide receivers, tight ends) included time to return to competition and yearly total yards and touchdowns. Outcomes data collected for defensive players (defensive linemen, linebackers, defensive backs) included time to return to competition and yearly total tackles, sacks, and interceptions. Offensive power ratings (OPR=total yards/10 + total touchdowns x6) and defensive power ratings (DPR=total tackles + total sacks x2 + total interceptions x2) were calculated for the injury season and for 3 seasons before and after the injury season. Offensive and defensive control groups consisted of all players of similar positions without an identified Lisfranc injury that competed in the 2005 season. Results: Lisfranc injuries were identified in 28 NFL athletes in the study period, including 11 offensive players and 17 defensive players. While 2 of 28 (7.1%) players never returned to the NFL, the remaining 26 (92.9%) athletes returned to competition at a median 11.1 (interquartile range: 10.3-12.5) months from time of injury and missed a median 8.5 (6.3-13.0) NFL regular season games. Players treated non-operatively were noted to have an earlier return to play with a median absence from play of 6.2 (1.9-10.7) months and 7.0 (4.5-8.0) games compared to those treated operatively who returned after a median 11.6 (10.7-12.6) months (p=0.02) and 10.0 (7.0-13.3) games missed (p=0.09). Analysis of pre-and post-injury athletic performance revealed no statistically significant changes following return to sport after Lisfranc injury. The magnitude of change in median OPR for 3 seasons prior to index season compared to 3 seasons after index season observed in the Lisfranc-injured offensive study group, -34.8 (-64.4-1.4), was greater than that observed in the offensive control group, -18.8 (-52.9-31.5); however, these differences did not reach statistical significance (p=0.33). Similarly, the magnitude of change observed in the Lisfranc-injured defensive study group, -13.5 (-30.9-4.3), was greater than that observed in the defensive control group, -5.0 (-22.0-14.0); however, these differences also did not reach statistical significance (p=0.21). Conclusion: Greater than 90% of NFL athletes who sustained Lisfranc injuries returned to play in the NFL at a median 11.1 months from time of injury. Operative treatm...

A Systematic Review of the Orthopaedic Literature Involving National Football League Players

“…Lisfranc sprains in NFL Combine participants were shown to negatively affect draft position and player availability, particularly when >2-mm residual displacement is present, while internet data of Lisfranc sprains in NFL players showed >90% RTP at a median of 11 months with no effect on performance or career length. 90,91 Type 1 and 2 injuries were treated nonoperatively, with RTP within 1 week for grade 1 and at 5 weeks for grade 2, while grade 3 injuries required surgery but allowed eventual RTP. 104…”

Return to Sport after Surgical Treatment of Lisfranc Injuries in Athletes: A Retrospective Case Series

“…The majority of patients continued to have some pain with their respective sport. Current literature lacks substantial information for injured athletes with ligamentous Lisfranc injuries with respect to ability to return to sport as well as the timeline for return to their respective sport after surgery 6,13–15. This analysis provided a baseline for healthcare providers as well as patients to have an educated discussion on estimated return to play after a ligamentous Lisfranc injury.…”

“…The other athletes, retired from gymnastics, were lost to follow-up, or graduated from college. The authors concluded that “Lisfranc injuries were most likely career-ending.”14 More recently, McHale et al15 looked at the return to play outcomes in 28 national football players with Lisfranc injuries. They found that with patients that needed surgical intervention for their Lisfranc injury that the average return to sport was 49.9 (range; 46.0 – 54.2) weeks.…”

Military personnel sustaining Lisfranc injuries have high rates of disability separation

“…MacMahon et al 7 retrospectively examined the results of midfoot arthrodesis after Lisfranc injury in athletes; three-quarters of their patients had returned to the same level of sports participation at a mean of 5.2 years after surgery, although two-thirds reported some difficulty in participation due to pain. McHale et al 6 reported that 28 Lisfranc injuries occurring in the National Football League (NFL) (American football). In their series, 93% returned to play, and there was no difference in statistical production preinjury and postinjury.…”

“…Previous studies have shown generally good outcomes with surgical treatment, with relatively high rates of return to sporting activity among athletes 6 7. However, the optimal treatment of these injuries remains controversial, and nearly all clinical series report high rates of secondary procedures and post-traumatic osteoarthritis after initial treatment.…”