SLR - July 2020 - Jeffrey R. Sanker
Surgical Outcome of Chronic Lisfranc Injury without Secondary Degenerative Arthritis: A Systematic Literature Review
Reference: Sripanich Y, Weinberg MW, Krähenbühl N, et al. Surgical Outcome of Chronic Lisfranc Injury without Secondary Degenerative Arthritis: A Systematic Literature Review [published online ahead of print, 2020 Apr 11. Injury. 2020; S0020-1383(20)30315-6.
Scientific Literature Review
Reviewed By: Jeffrey R. Sanker, DPM
Residency Program: Kaiser SF Bay Area Foot & Ankle – Oakland, CA
Podiatric Relevance: Nearly one third of patients with Lisfranc injuries are misdiagnosed at the time of their initial presentation. A delay in diagnosis may lend itself to chronic instability at the midfoot, degenerative changes, and physical disabilities. Selecting the most appropriate treatment option for patients with chronic Lisfranc injuries can be challenging when no signs of arthritis exist. There is a paucity of literature on the operative outcomes following treatment of chronic Lisfranc instability without arthritis, which this study attempts to address.
Methods: This is a systematic review of studies assessing the outcome of patients treated surgically for chronic Lisfranc injuries without secondary osteoarthritis by two reviewers. Data extracted included the number of patients and feet, study design, time between injury and operation, age, mechanism of injury, injury type, indications for surgery, pre-operative assessment, post-operative follow up time, time to return to activity and clinical outcome. Outcomes were measured most frequently with the American Orthopaedic Foot and Ankle Score (AOFAS).
Results: While 6,845 studies were relevant, 10 outcome studies were included in the final analysis. All studies were retrospective case series including a total of 70 patients at a single center, except for one multicentered study. Time between injury and surgical treatment averaged 5.3 months. A variety of operative techniques and fixation constructs were performed, including open reduction internal fixation, arthrodesis, external fixation, etc. An average pre-operative AOFAS score of 55.7 improved to 88.1 at final follow-up after operative treatment. Low complication rates and good functional outcomes were described.
Conclusions: Limited articles assessing surgical outcomes of chronic Lisfranc injuries without secondary osteoarthritis has not provided surgeons with a definitive consensus on management. This is the first systematic review looking at this group of patients. The authors find patient outcomes are improved and post-surgical complications are few following surgical repair despite delayed diagnosis. However, further studies of a larger cohort and less variation in treatment and postoperative procedures may better inform providers on the management of chronic Lisfranc injuries.