Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes

Mora, Allan David; Kao, Mark; Alfred, Terrence; Shein, Gregory; Ling, Jeff; Lunz, David

doi:10.1177/1071100718765176

Cited by 19 publications

(11 citation statements)

References 25 publications

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“…Excluding a player who retired because of the injury, the average return to training for this group was 19.3 weeks, and the average return to competition was 24.1 weeks. 15 Similarly, in Mora et al, 27 all 33 recreational athletes underwent removal of hardware 6 months postoperatively and returned to unrestricted sporting activities by 8 months. In a third study also reporting the use of screw fixation by Vosbikian et al, 38 the active patients wanting optimal motion without risk for hardware failure underwent a second operation to remove hardware at a mean of 6.9 months after the initial operation.…”

Section: Discussionmentioning

confidence: 94%

Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review

Sullivan

Peckston

Alpuerto

2022

Orthopaedic Journal of Sports Medicine

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Background: Isolated unstable Lisfranc ligament injuries in elite athletes are associated with a lengthy period of rehabilitation and prolonged absence from competition. Purpose: To assess the efficacy of a knotless, interosseous suture button system for repairing isolated unstable ligamentous Lisfranc injuries and its capacity to allow accelerated rehabilitation with earlier weightbearing and return-to-play times in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed data from a prospectively compiled database for elite athletes treated by a single surgeon. All included patients had clinical and magnetic resonance imaging evidence of an unstable isolated complete ligamentous Lisfranc injury requiring surgical reduction and stabilization. All patients underwent surgery using a knotless interosseous suture button to achieve stabilization, followed by a standardized postoperative regimen involving full weightbearing at 4 weeks, and all had a minimum postoperative follow-up of 2 years. Results: Included were 12 patients: 7 National Rugby League (NRL) players, 2 professional dancers, 1 Olympic gymnast, 1 professional wakeboarder, and 1 professional NRL referee. The mean age of the patients was 21.1 years (range, 16-34 years). Ten patients underwent acute surgical stabilization within 3 weeks of the injury, and 2 patients sustained chronic isolated Lisfranc instability that was initially treated nonoperatively. All athletes were able to return to full weightbearing by 4 weeks postoperatively, successfully returned to training by 9 to 12 weeks, and returned to full competition by 12 to 16 weeks. No major complications were reported. Conclusion: Knotless interosseous suture button stabilization was a reliable treatment option for both acute and chronic isolated ligamentous Lisfranc injuries in these elite athletes. This technique does not require hardware removal, allows early weightbearing with accelerated rehabilitation, and may shorten the return-to-play interval.

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Section: Discussionmentioning

confidence: 94%

Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review

Sullivan

Peckston

Alpuerto

2022

Orthopaedic Journal of Sports Medicine

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“… 21 Previous studies reporting on RTP after a Lisfranc injury in athletes have had similar or lower sample sizes. 2 , 11 , 16 , 18 , 21 Most Lisfranc injuries were experienced by offensive linemen (n = 8; 24.2%), followed by running backs (n = 7; 21.2%). The median RTP time was 11.0 months (IQR, 10.2-11.8).…”

Section: Discussionmentioning

confidence: 99%

Return to Play, Performance, and Economic Analysis of National Football League Players After Lisfranc Injury

Abed

Fine

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: A Lisfranc injury can occur to either the ligament or bone, which causes instability when attempting to perform strength and balance maneuvers. Purpose/Hypothesis: The study's aims were to (1) analyze the return-to-play (RTP) rate and performance level of players in the National Football League (NFL) after Lisfranc injury and (2) determine the economic and financial impact of Lisfranc injuries to the NFL. We hypothesized that there would be a low RTP rate following Lisfranc injury in the NFL. Study Design: Case series; Level of evidence, 4. Methods: Multiple online public records were used to identify NFL players with Lisfranc injuries between the 2009 and 2020 seasons. Players were assessed according to their RTP statistics: snap count, approximate value (AV), games played, and games started. Nonparametric methods were used to compare player statistics before and after injury. Also, player salaries while injured were calculated (in 2022 US dollars after adjusting for inflation) to approximate economic loss for those players who returned to play. Results: A total of 33 NFL athletes sustained a Lisfranc injury during the study period. Most Lisfranc injuries were experienced by offensive linemen (n = 8; 24.2%), followed by running backs (n = 7; 21.2%). Overall 27 players (81.8%) returned to play after injury at a median of 11.0 months (IQR, 10.2-11.8 months). There were no significant differences between pre- and postinjury snap counts or number of games played and started. In terms of player performance, there was a statistically significant decrease in AV at 1 year postinjury (median [IQR], 6.0 [4.0-10.0] preinjury vs 5.0 [2.5-7.5] postinjury; P = .022). The overall cost of recovery amounted to $104.7 million, with quarterbacks (n = 4) accounting for the greatest cost at $32.6 million. The next 2 most expensive positions were offensive and defensive linemen (n = 5 each) at $19.4 million each. Conclusion: Our results did not support the hypothesis, as the RTP rate for NFL athletes sustaining Lisfranc injuries was 81.8%. This injury was associated with a significant decrease in AV 1 year postinjury. In terms of economic impact, quarterbacks accounted for almost one-third of expenses while constituting only 14.8% of injuries.

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“…However, these studies highlight the fact that the development of radiographic osteoarthritis does not in itself necessitate secondary arthrodesis and patients should be assessed for symptom correlation and not through radiographs alone. Given the young age of many patients in this cohort, return to activity, including sport after treatment, has been addressed in recent literature 9,20,[91][92][93][94][95] . Rates of return to sport of 94%, with nearly three-quarters returning to preinjury levels, have been reported in a recent meta-analysis 92 .…”

Section: Treatment Outcomesmentioning

confidence: 99%

Management of Lisfranc Injuries

et al. 2023

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There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations.Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury.Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries.Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area.We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.

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Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes

Abstract: Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

Cited by 19 publications

References 25 publications

Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review

Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review

Return to Play, Performance, and Economic Analysis of National Football League Players After Lisfranc Injury

Management of Lisfranc Injuries

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