The Epidemiology of Lisfranc Injuries at the National Football League Combine and its Impact on an Athlete’s National Football League Career

OBJECTIVES: Lisfranc injuries may have a detrimental effect on athletic performance and an athlete’s career. Understanding the epidemiology of these injuries in collegiate football players and their impact on future performance may assist team physicians in counseling injured athletes and determining optimal treatment. The purposes of this study are to 1) determine the epidemiology of navicular fractures in players participating in the NFL Combine, 2) define positions and demographics that might be at higher risk for sustaining this injury, and 3) evaluate the radiographic healing and eventual impact the injury and radiographic findings has on Lisfranc injuries on NFL draft position and NFL game play compared to matched controls. METHODS: All players who sustained a Lisfranc injury prior to Combine evaluation between 2009 and 2015 were evaluated. The prevalence, positions affected, treatment methods, and number of missed collegiate games were recorded. Radiographic outcomes were analyzed via Combine radiograph findings, while NFL performance outcomes were assessed for all Lisfranc injuries (2009-13) compared to matched controls in first two years of play. RESULTS: A total of 41/2162 (1.8%) Combine participants were identified with Lisfranc injuries, of which 26/41 (63.4%) were managed operatively. When compared to players managed nonoperatively, those who underwent surgery were more likely to go undrafted (38.5% vs. 13.3%, p=0.04) and featured a worse NFL draft pick position (155.6 vs. 109, p=0.03). Lisfranc-injured players were noted to have a worse NFL draft position (142 vs. 111.3, p=0.04), NFL career length ≥2 years (62.5% vs. 69.6%, p=0.23) and fewer games played (16.9 vs. 23.3, p=0.001) and started (6.8 vs. 10.5, p=0.08) within the first two years of NFL career versus controls. Radiographs demonstrated 17/41 (41.5%) athletes with residual Lisfranc joint displacement >2mm compared to the contralateral foot. Lisfranc-injured athletes with >2mm residual displacement had lower draft position (111.2 vs. 156.9, p=0.009), and fewer games played (23.3 vs. 14.4, p=0.001) and started (10.5 vs. 3,1, p=0.03) versus matched controls. Moreover, athletes with >2mm residual displacement featured worse outcomes across all assessed NFL variables versus athletes with ≤2mm residual displacement. CONCLUSION: Lisfranc injuries identified at the NFL Combine have an adverse effect on an NFL athlete’s draft status, draft position and overall play during initial NFL seasons. In particular, residual displacement of the Lisfranc joint has a detrimental impact on the first two seasons of NFL play and may lead to long lasting negative effects on career.