Kenneth J. Mroczek, MD, comments on Mora A, Kao M, Alfred T, Shein G, Ling J, Lunz D. Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes. FAI 2018: 801-7.
In a retrospective review, Mora et al assessed the return to sports and physical activity in 33 adult patients age 55 and younger who underwent open reduction and internal fixation (ORIF) for a Lisfranc injury. Follow-up was a minimum of 18 months.
The fixation method included a Lisfranc screw from the medial cuneiform to the second metatarsal base and bridge plating of the involved tarsometatarsal joints. The hardware was removed 6 months after surgery. The results were measured with a new sports-specific, patient-administered questionnaire and the Foot and Ankle Outcome Score (FAOS).
Ninety-four percent of patients returned to sporting activity in some form, with 66% returning to the same or higher level than preinjury. Within the subgroup of 11 patients who participated less in sports than preinjury, 6 patients reported persistent pain but the other 6 cited lifestyle reasons for their lack of sports participation. Eighty percent of the patients reported that they were not limited by their injury or ongoing symptoms.
This study provides helpful information for recreational athletes who have sustained Lisfranc injuries requiring operative intervention. The results indicate that “weekend warriors” should be able to return to some form of sporting activity. Furthermore, any ongoing symptoms seem to be relatively minor in that they did not affect activity level in this study.
Controversy exists regarding ORIF versus primary fusion in patients with Lisfranc injuries. There is also debate on the choice of fixation when a surgeon chooses ORIF. The internal fixation technique used by Mora et al avoids intra-articular screws, which can cause articular cartilage damage. Bridge plating allows preservation of the articular cartilage, but until further data are available, surgeons should choose the technique that allows the best anatomic reduction of the fracture and joint in their experience.
Limitations of this study includes:
- Its retrospective nature
- The lack of validation of the questionnaires with respect to Lisfranc injuries
- The relatively short-term follow-up of 18 months
Further studies are needed to determine if post-traumatic arthritis develops and if surgical intervention with ORIF limit sporting activity at longer-term follow-up.
Kenneth J. Mroczek, MD, is an Assistant Professor of Orthopaedic Surgery and Chief of the Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, at NYU Langone Health, New York, New York.
The author has no disclosures relevant to this article.
This article was originally published as Most Patients Could Return to Sport and Physical Activity after ORIF for Lisfranc Injury in the NYU Langone Orthopedics Journal Watch section of www.ICJR.net. Republished with permission.