Operative treatment of Lisfranc injuries in elite athletes: 2024 International Foot and Ankle Sports Consensus and systematic review

IF 5.5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-08-24 Epub Date: 2026-02-06 DOI:10.1002/ksa.70261

Julia M. Balboni, Arielle Richey Levine, Vanessa J. Boggiano, Kassidy J. Webber, Scott D. Semelsberger, Sebastian Krebsbach, James Butler, M. Diane Essis, Brendan Conroy, IFASC Committee, Arianna L. Gianakos

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引用次数: 0

Abstract

Purpose

Lisfranc injuries are potentially career-threatening for athletes, yet optimal management of unstable ligament and fracture-dislocation injury patterns remains debated. This study integrates an international expert consensus with a systematic review to evaluate current surgical strategies and outcomes, aiming to establish evidence-based recommendations for the treatment of elite athletes and to optimize recovery and return to play.

Methods

A systematic review evaluated post-operative outcomes following suture button fixation (SBF), open reduction internal fixation (ORIF) and arthrodesis of unstable ligament and fracture-dislocation Lisfranc injuries. In addition, a consensus process was conducted using a modified Delphi technique. All consensus questions were generated by an initial survey sent to the expert panel. General consensus was defined as 75%–85% agreement, strong consensus as 86%–99% agreement and unanimous consensus as 100% agreement.

Results

Sixteen studies (n = 406 athletes) were included. In the unstable ligament group, SBF (n = 46) versus ORIF (n = 203) yielded higher American Orthopaedic Foot and Ankle Society (95.5 vs. 89.4), lower complications (10.9% vs. 18.2%), zero failures (0% vs. 4.9%) and fewer secondary procedures (0% vs. 30.5%), with 93.5% of ORIF reoperations being hardware removal. In fracture-dislocation injury patterns, ORIF (n = 123) and arthrodesis (n = 31) showed similar complication (30.8% vs. 35.5%) and failure rates (13.8% vs. 12.9%), with secondary procedures more frequent after ORIF (90.2% vs. 22.6%). The consensus process generated 16 statements: 12 achieved unanimous agreement and 4 achieved strong consensus.

Conclusion

Elite athletes who present with unstable ligament Lisfranc injuries and indications for surgical intervention should undergo fixation rather than fusion. For bony and fracture-dislocation Lisfranc injuries, ORIF is preferred when joint surfaces are salvageable and arthrodesis when long-term preservation is not feasible. However, the findings of this study underscore the importance of individualized treatment strategies to optimize surgical outcomes and functional recovery.

Level of Evidence

Level V.

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优秀运动员Lisfranc损伤的手术治疗：2024年国际足踝运动共识与系统回顾。

目的：对于运动员来说，Lisfranc损伤是潜在的职业威胁，然而不稳定韧带和骨折脱位损伤模式的最佳管理仍然存在争议。本研究整合了国际专家共识和系统回顾，以评估当前的手术策略和结果，旨在为精英运动员的治疗建立循证建议，并优化恢复和恢复比赛。方法：系统评价缝合扣固定（SBF）、切开复位内固定（ORIF）和关节融合术治疗不稳定韧带和骨折脱位型Lisfranc损伤的术后疗效。此外，使用改进的德尔菲技术进行共识过程。所有协商一致的问题都是由发给专家组的初步调查产生的。一般一致定义为75%-85%一致，强烈一致定义为86%-99%一致，一致定义为100%一致。结果：纳入16项研究（n = 406名运动员）。在不稳定韧带组，SBF （n = 46）与ORIF （n = 203）相比，美国骨科足踝学会（95.5比89.4）更高，并发症更低（10.9%比18.2%），零失败（0%比4.9%）和更少的二次手术（0%比30.5%），93.5%的ORIF再手术是取出硬体。在骨折脱位损伤模式中，ORIF （n = 123）和关节融合术（n = 31）出现相似的并发症（30.8%对35.5%）和失败率（13.8%对12.9%），ORIF后的二次手术更频繁（90.2%对22.6%）。协商一致进程产生了16项声明：12项达成一致意见，4项达成强烈共识。结论：表现为不稳定韧带Lisfranc损伤的优秀运动员和手术干预指征应该进行固定而不是融合。对于骨性和骨折脱位性Lisfranc损伤，当关节表面可修复时，首选ORIF，而当长期保存不可行时，首选关节融合术。然而，本研究的结果强调了个性化治疗策略对优化手术结果和功能恢复的重要性。证据等级：V级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).