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Category: Midfoot/Forefoot; Other Introduction/Purpose: A longitudinal Lisfranc variant injury occurs from a longitudinal force on the midfoot directed through the first ray and medial cuneiform. This is unique in that other Lisfranc injury patterns typically result from an axial-directed force or a rotational force that externally rotates the midfoot. More common Lisfranc injury patterns can have instability longitudinally, but usually it is accompanied by coronal instability and even axial instability. To date, there has been no study with a cohort of Lisfranc injuries with isolated longitudinal instability. The purpose of this study was to report patient-reported outcome measures (PROMs) for those undergoing surgical treatment for longitudinal Lisfranc injuries. Methods: Retrospective chart review was completed to identify patients with surgically treated longitudinal Lisfranc injuries by a single surgeon between April 2018 and February 2022. Intraoperative fluoroscopy was used to confirm Lisfranc injuries positive for only longitudinal instability and negative for coronal and axial instability. Surgical technique consisted of open reduction internal fixation (ORIF) with a compression screw from the medial to middle cuneiform and a "homerun" compression screw from the medial cuneiform to the base of the second metatarsal. PROMs, collected preoperatively and postoperatively, included the Foot and Ankle Ability Measure (FAAM), Veterans RAND 12-Item Health Survey (VR-12), and visual analog scale (VAS) pain scale. Patient satisfaction was assessed through a survey consisting of a 0-100 rating scale with "least satisfied" being 0 and "most satisfied" being 100. Statistical analyses to determine significance were completed through sample t-tests assuming unequal variance with significance set at P<.05. Results: Fourteen patients (14 feet) with an average age of 25.2±15.7 years sustained longitudinal Lisfranc injuries. Eleven of 14 patients competed in competitive sports when injured with football (n=5) being the most prevalent sport. Eleven patients underwent hardware removal an average of 3.6 months following their primary surgery. There were three cases of broken hardware, and one revision in which ORIF was converted to fusion. The average latest follow-up time for PROMs were 25.9 (range, 12-44) months. Results demonstrate a significant improvement in FAAM Total, FAAM ADL, and FAAM Sports scores at latest follow-up (Figure 1). There was also improvement in VR-12 Mental, VR-12 Physical, and VAS scores, though not statistically significant. Mean patient satisfaction at latest follow-up was 99/100. Conclusion: This study is the first to present data from a cohort of isolated longitudinal Lisfranc injuries. There is significant debate about surgical management of Lisfranc injuries. The improvement in PROMs at latest follow-up and high patient satisfaction suggests that ORIF may be an optimal surgical approach for management of longitudinal Lisfranc injuries. [ABSTRACT FROM AUTHOR]

Category: Sports; Midfoot/Forefoot Introduction/Purpose: The relative incidence of Lisfranc injuries amongst competitive athletes is higher than the incidence in the general population. Lisfranc injuries can be particularly devastating to competitive athletes. They can dramatically hinder athletic performance, cause severe midfoot pain, and are difficult to diagnose. It is well documented that many Lisfranc injuries are initially misdiagnosed. To date, there is limited literature surrounding return-to-sport timelines and outcomes following operatively managed Lisfranc injuries in competitive athletes. The purpose of this study is to present an average return-to-sport timeline and patient-reported outcomes of surgically treated Lisfranc injuries in competitive athletes. Methods: Patients with surgically treated Lisfranc injuries by a single surgeon between May 2012 and February 2022 were identified through retrospective chart review. Competitive athletes and their levels of athletic competition were identified through clinical and surgical documentation. Patients with surgically treated Lisfranc injuries that were not active competitive athletes at the time of injury were excluded. Data from a novel Lisfranc return-to-sport survey was prospectively collected. Patient-reported outcome measures (PROMs) analyzed included the visual analog scale (VAS) pain scale, Veterans RAND 12-Item Health Survey (VR-12), and the Foot and Ankle Ability Measure (FAAM). PROMs with latest follow-up less than 12 months from the date of surgery were excluded from analysis. The differences between mean preoperative and mean latest follow-up outcome measures were analyzed using simple t tests with significance set at P<.05. Results: Forty-six competitive athletes were surgically treated for Lisfranc injuries. All PROMs demonstrated statistically significant improvement upon latest follow-up except for the VR-12 Mental (Table 1). Nine patients (9/46) were lost to follow-up. Thirty- two patients (86.5%, 32/37) completed the Lisfranc return-to-sport survey at a mean follow-up time of 52.17 (range, 7.33-125.26) months after surgery. Twenty-eight patients (28/32) desired to return to play, and four did not (4/32). Twenty-seven patients (96.4%, 27/28) successfully returned to sport after an average of 5.5 (range, 3-12) months. Twenty-two patients (22/28) eventually returned to pre-injury levels of play, and six (6/28) did not. Average pain levels when returning to play were 26.2/100. Twenty- three patients (23/28) were eventually able to play pain free. Overall average patient satisfaction level was 95.6/100. Conclusion: This study is one of the largest known cohorts (n=46) of competitive athletes with operatively managed Lisfranc injuries to have return-to-sport time and PROMs analyzed. Overall, the return-to-sport rate, PROMs, and patient satisfaction levels were excellent for this cohort. Of the athletes who desired to return-to-sport, the return-to-sport rate was 96.4% with a mean return-to-sport time of 5.5 (range, 3-12) months after surgery. All PROMs (VAS, VR-12 Physical, FAAM) except for the VR- 12 Mental demonstrated statistically significant improvement at latest follow-up. [ABSTRACT FROM AUTHOR]

Category: Midfoot/Forefoot; Other Introduction/Purpose: Lisfranc injury presentations can vary from a mild sports-related midfoot sprain to severe midfoot deformity caused by a motor vehicle accident. Despite this, Lisfranc injuries are not highly prevalent. Lisfranc injuries are often difficult to diagnose, making it possible that the prevalence of these injuries is underreported. It is widely accepted that surgery to correct a Lisfranc injury should be performed as soon as possible since chronic injuries are associated with higher rates of midfoot degenerative changes. Chronic Lisfranc injuries are more commonly treated with primary arthrodesis (PA) "salvage" procedures rather than open reduction internal fixations (ORIF). The purpose of this study was to compare the patient-reported outcome measures (PROMs) after surgery for patients with acute Lisfranc injuries to patients with chronic Lisfranc injuries. Methods: Retrospective chart review was completed to identify patients with surgically treated Lisfranc injuries by a single surgeon between May 2012 and February 2022. Acute versus chronic injury distinction was based on the amount of time between the date of injury and the date of surgery with the cutoff set at six weeks. Ambiguous injury timelines determined through clinical and surgical documentation were excluded. The acute and chronic cohorts were age-gender matched. PROMs, collected preoperatively and postoperatively, included the Foot and Ankle Ability Measure (FAAM), Veterans RAND 12-Item Health Survey (VR-12), and visual analog scale (VAS) pain scale. Patient satisfaction was assessed through a survey consisting of a 0-100 rating scale with "least satisfied" being 0 and "most satisfied" being 100. Latest follow-up PROMs < 12 months were excluded from analysis. Statistical analyses to determine significance were completed through sample t-tests assuming unequal variance with significance set at P<.05. Results: Acute and chronic injury cohorts consisted of 42 patients (42 feet) each, and the average age of both cohorts were 36.58±16.89 years and 36.70±16.65 years, respectively. In the acute cohort, 24 ORIFs and 18 PAs were performed compared to 16 ORIFs and 26 PAs in the chronic cohort. The average latest follow-up time for PROMs for acute and chronic cohorts were 36.02 (range, 12-78) months and 27.72 (range, 12-48) months, respectively. The acute cohort demonstrated significantly lower FAAM scores preoperatively, but no significant preoperative VAS differences were found. Both acute and chronic cohorts individually had significant improvement in the FAAM from preoperative to latest follow-up, but there were no significant differences found between the PROMs at latest follow-up of both cohorts (Table 1). Conclusion: This study directly comparing acute versus chronic Lisfranc injury PROMs after surgery is the first of its kind. The results concluded there were no significant differences found between the latest follow-up PROMs. These findings are despite a higher proportion of PAs to ORIFs in the chronic cohort, which some published studies have concluded to be the superior surgical technique. This study supports the notion to treat surgically indicated Lisfranc injuries acutely. [ABSTRACT FROM AUTHOR]