Surgical outcome of chronic Lisfranc injury without secondary degenerative arthritis: A systematic literature review

• Published in: Injury 2020-06, Vol.51 (6), p.1258-1265
• Main Authors: Sripanich, Yantarat, Weinberg, Maxwell W., Krähenbühl, Nicola, Rungprai, Chamnanni, Haller, Justin, Saltzman, Charles L., Barg, Alexej
• Format: Article
• Language: English
• Subjects: Arthrodesis - statistics & numerical data; Chronic; Foot Injuries - surgery; Foot Joints - surgery; Fracture Fixation, Internal - methods; Fracture Fixation, Internal - statistics & numerical data; Humans; Lisfranc; Outcomes; Patient Satisfaction - statistics & numerical data; Postoperative Complications; Surgery; Tarsometatarsal; Treatment Outcome
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.04.005

•A limited number of studies have evaluated surgical outcomes for this condition.•The most frequent study design was a retrospective case series.•Few surgical techniques are used to treat chronic Lisfranc injuries without arthritis.•Patient outcome scores (AOFAS) and pain relief improve after surgical intervention. Chronic Lisfranc joint injuries (tarsometatarsal, TMT) can present as a variety of clinical symptoms and radiographic findings. If significant arthritis at the Lisfranc joint is present, salvage arthrodesis is an option. For patients who receive a delayed diagnosis and/or present with no signs of arthritic changes, selecting the most appropriate treatment can be challenging. This article provides a systematic review of current surgical treatment options and outcomes for patients with a chronic Lisfranc injury but no secondary degenerative changes. Four major medical databases were searched from inception through March 5, 2019: PubMed, Science Direct, Scopus, and Embase. Studies were included if they were original research studies that assessed the outcome of patients treated surgically for chronic Lisfranc injuries without secondary osteoarthritic changes. Only studies written in English and German were considered. The following data were recorded from each study: number of patients and feet included, study design (prospective vs. retrospective, single vs. multicenter, level of evidence), time between initial injury and operation, operative techniques, age, mechanism of injury, type of injury (purely ligamentous or ligamentous with concomitant bony fractures), indications for surgery, pre-operative assessment, postoperative follow-up time, time to return to activity or sport, and clinical outcome. The modified Coleman Score was used to assess the methodologic quality of the included studies. Of the 6,845 screened, ten studies met the above criteria and were included. All but one were single center studies. All studies were either retrospective or prospective case series. Overall, studies generally reported low complication rates and good functional outcomes. Postoperative outcomes were most frequently measured with the American Orthopaedic Foot and Ankle (AOFAS) score; the overall mean preoperative AOFAS scores of 55.7 significantly improved to 88.1 at final follow-up. No definitive consensus exists on how Lisfranc instability without concurrent osteoarthritis should be surgically managed. Despite the delay in diagnosis, patients who undergo sur