SLR - November 2016 - Peter Ferrante
Reference: McHale KJ, Rozell JC, Milby AH, Carey JL, Sennett BJ. Outcomes of Lisfranc Injuries in the National Football League. Am J Sports Med. 2016 Jul;44(7): 1810–817.Scientific Literature Review
Reviewed By: Peter Ferrante, DPM
Residency Program: NYU Lutheran Medical Center
Podiatric Relevance: This article compares outcomes of Lisfranc injuries and their treatment modalities, and whether the outcomes have a direct impact on performance and return to athletic competition. For the podiatric surgeon, it is interesting to compare modalities and effects of Lisfranc treatments in patients who are extraordinarily active and who every week for multiple months of the year, put the utmost strain on their bones and joints.
Methods: Data for the study was done retrospectively on players in the National Football League who sustained a Lisfranc injury over a 10-year period (2000–2010). The injuries were identified using NFL game summaries, weekly team injury reports and player profiles. The players analyzed were taken from both offensive and defensive sides of the field, and involved running back, wide receiver, tight end, defensive lineman, linebacker, or defensive back. These positions were included because their performances could be objectively measured. Players were excluded if they did not participate in at least one regular season before the season of injury. Variables included age, experience, position, date of injury, date of return to NFL, games played and operative vs. nonoperative. Player's performance analysis was performed utilizing a comparison of the player three seasons prior to the injury and three seasons postinjury, as well as a control group for a similar time period. Athletic performance was determined through offensive power ratings and defensive power ratings. Postinjury durability was determined through total games played after the season of injury.
Results: Two of 28 players never returned to the NFL, and the 26 players who returned to competition did so after a median of 11.1 months from time of injury. There was no significant difference in time to return to play when comparing offensive and defensive players. Players treated nonoperatively returned to action sooner than those treated operatively with a median of 6.2 months compared to 11.6 months, respectively. Both offensive and defensive player performance analysis revealed no statistical significance in athletic performance after return from Lisfranc injury, but it showed a slight decrease in performance. Analysis of durability also revealed no significant difference in career lengths post Lisfranc injury.
Conclusions: Although there were slight declines in performance for both offensive and defensive players, the author concluded that it was statistically insignificant. The articles that were precursory to the study relayed shorter healing times, which was noted to be possible because NFL athletes put unique demands on the tarsometatarsal joint and therefore cannot be compared with the study populations of previous studies. The dissimilarity in operative and nonoperative Lisfranc treatment return to play was explained as a significant difference in the number of patients who required surgery (22) and those who got away without surgery (6), as compared to previous studies, which had higher rates following conservative care. Performance outcomes were examined using power ratings, which are calculated and relay a single value encompassing multiple facets of performance. However, using a single value to assess performance cannot be fully comprehensive to all aspects that make or break a football player’s performance, and it does not take into account strength, speed and experience. Nonsurgical treatment for Lisfranc injuries may result in the athletes returning to the field quicker; however, no study has been done to retrospectively analyze arthritic changes and pain many years after retirement from the NFL. Specifically, for podiatric surgeons, since there are no other studies evaluating return to activities in athletes, this study can be a good reference for treating high school or college athletes, which many podiatrists treat on a daily basis. This article can lay the groundwork to relaying realistic expectations to recovery time and return to the field for athletes and individuals who put more strain on their bodies than the average person.