Outcomes of Lisfranc Injuries in the National Football League

OBJECTIVES: Tarsometatarsal (Lisfranc) joint injuries commonly occur in American professional football competition; however, the career impact of these injuries is unknown. This study aims to define the time to return to competition for professional football players who sustained Lisfranc injuries and to quantify their effect on athletic performance. METHODS: Data on National Football League (NFL) players who sustained a Lisfranc injury during a ten-year time period (2000-2010) were collected for analysis. Recorded demographic variables included age, experience, position, and operative vs. non-operative management. Outcomes data collected for offensive players (running backs, wide receivers, tight ends) included time to return to competition and yearly total yards and touchdowns. Outcomes data collected for defensive players (defensive linemen, linebackers, defensive backs) included time to return to competition and yearly total tackles, sacks, and interceptions. Offensive power ratings (OPR=total yards/10 + total touchdowns x6) and defensive power ratings (DPR=total tackles + total sacks x2 + total interceptions x2) were calculated for the injury season and for 3 seasons before and after the injury season. Offensive and defensive control groups consisted of all players of similar positions without an identified Lisfranc injury that competed in the 2005 season. RESULTS: Lisfranc injuries were identified in 28 NFL athletes in the study period, including 11 offensive players and 17 defensive players. While 2 of 28 (7.1%) players never returned to the NFL, the remaining 26 (92.9%) athletes returned to competition at a median 11.1 (interquartile range: 10.3-12.5) months from time of injury and missed a median 8.5 (6.3-13.0) NFL regular season games. Players treated non-operatively were noted to have an earlier return to play with a median absence from play of 6.2 (1.9-10.7) months and 7.0 (4.5-8.0) games compared to those treated operatively who returned after a median 11.6 (10.7-12.6) months (p=0.02) and 10.0 (7.0-13.3) games missed (p=0.09). Analysis of pre- and post-injury athletic performance revealed no statistically significant changes following return to sport after Lisfranc injury. The magnitude of change in median OPR for 3 seasons prior to index season compared to 3 seasons after index season observed in the Lisfranc-injured offensive study group, -34.8 (-64.4-1.4), was greater than that observed in the offensive control group, -18.8 (-52.9-31.5); however, these differences did not reach statistical significance (p=0.33). Similarly, the magnitude of change observed in the Lisfranc-injured defensive study group, -13.5 (-30.9-4.3), was greater than that observed in the defensive control group, -5.0 (-22.0-14.0); however, these differences also did not reach statistical significance (p=0.21). CONCLUSION: Greater than 90% of NFL athletes who sustained Lisfranc injuries returned to play in the NFL at a median 11.1 months from time of injury. Operative treatment was associated with a longer time to return; however, this is a potential surrogate for greater injury severity. Offensive and defensive players experienced a decrease in performance after return from injury that did not reach statistical significance when compared to their respective control groups over a similar time period.