Surgical outcome of chronic Lisfranc injury without secondary degenerative arthritis

TY - JOUR

T1 - Surgical outcome of chronic Lisfranc injury without secondary degenerative arthritis

T2 - A systematic literature review✰

AU - Sripanich, Yantarat

AU - Weinberg, Maxwell W

AU - Krähenbühl, Nicola

AU - Rungprai, Chamnanni

AU - Haller, Justin

AU - Saltzman, Charles L

AU - Barg, Alexej

N1 - Copyright © 2020. Published by Elsevier Ltd.

PY - 2020/6

Y1 - 2020/6

N2 - BACKGROUND: Chronic Lisfranc joint injuries (tarsometatarsal, TMT) can present as a variety of clinical symptoms and radiographic findings. If significant arthritis at the Lisfranc joint is present, salvage arthrodesis is an option. For patients who receive a delayed diagnosis and/or present with no signs of arthritic changes, selecting the most appropriate treatment can be challenging. This article provides a systematic review of current surgical treatment options and outcomes for patients with a chronic Lisfranc injury but no secondary degenerative changes.METHODS: Four major medical databases were searched from inception through March 5, 2019: PubMed, Science Direct, Scopus, and Embase. Studies were included if they were original research studies that assessed the outcome of patients treated surgically for chronic Lisfranc injuries without secondary osteoarthritic changes. Only studies written in English and German were considered. The following data were recorded from each study: number of patients and feet included, study design (prospective vs. retrospective, single vs. multicenter, level of evidence), time between initial injury and operation, operative techniques, age, mechanism of injury, type of injury (purely ligamentous or ligamentous with concomitant bony fractures), indications for surgery, pre-operative assessment, postoperative follow-up time, time to return to activity or sport, and clinical outcome. The modified Coleman Score was used to assess the methodologic quality of the included studies.RESULTS: Of the 6,845 screened, ten studies met the above criteria and were included. All but one were single center studies. All studies were either retrospective or prospective case series. Overall, studies generally reported low complication rates and good functional outcomes. Postoperative outcomes were most frequently measured with the American Orthopaedic Foot and Ankle (AOFAS) score; the overall mean preoperative AOFAS scores of 55.7 significantly improved to 88.1 at final follow-up.CONCLUSIONS: No definitive consensus exists on how Lisfranc instability without concurrent osteoarthritis should be surgically managed. Despite the delay in diagnosis, patients who undergo surgical repair for chronic, unstable Lisfranc injury without osteoarthritis have improved patient outcome and few post-surgical complications. While the quality of these studies is satisfactory, a larger patient cohort and prospective analysis could further strengthen arguments for or against certain surgeries.LEVEL OF EVIDENCE: Level IV; Systematic Review of Level IV Studies.

AB - BACKGROUND: Chronic Lisfranc joint injuries (tarsometatarsal, TMT) can present as a variety of clinical symptoms and radiographic findings. If significant arthritis at the Lisfranc joint is present, salvage arthrodesis is an option. For patients who receive a delayed diagnosis and/or present with no signs of arthritic changes, selecting the most appropriate treatment can be challenging. This article provides a systematic review of current surgical treatment options and outcomes for patients with a chronic Lisfranc injury but no secondary degenerative changes.METHODS: Four major medical databases were searched from inception through March 5, 2019: PubMed, Science Direct, Scopus, and Embase. Studies were included if they were original research studies that assessed the outcome of patients treated surgically for chronic Lisfranc injuries without secondary osteoarthritic changes. Only studies written in English and German were considered. The following data were recorded from each study: number of patients and feet included, study design (prospective vs. retrospective, single vs. multicenter, level of evidence), time between initial injury and operation, operative techniques, age, mechanism of injury, type of injury (purely ligamentous or ligamentous with concomitant bony fractures), indications for surgery, pre-operative assessment, postoperative follow-up time, time to return to activity or sport, and clinical outcome. The modified Coleman Score was used to assess the methodologic quality of the included studies.RESULTS: Of the 6,845 screened, ten studies met the above criteria and were included. All but one were single center studies. All studies were either retrospective or prospective case series. Overall, studies generally reported low complication rates and good functional outcomes. Postoperative outcomes were most frequently measured with the American Orthopaedic Foot and Ankle (AOFAS) score; the overall mean preoperative AOFAS scores of 55.7 significantly improved to 88.1 at final follow-up.CONCLUSIONS: No definitive consensus exists on how Lisfranc instability without concurrent osteoarthritis should be surgically managed. Despite the delay in diagnosis, patients who undergo surgical repair for chronic, unstable Lisfranc injury without osteoarthritis have improved patient outcome and few post-surgical complications. While the quality of these studies is satisfactory, a larger patient cohort and prospective analysis could further strengthen arguments for or against certain surgeries.LEVEL OF EVIDENCE: Level IV; Systematic Review of Level IV Studies.

KW - Arthrodesis/statistics & numerical data

KW - Foot Injuries/surgery

KW - Foot Joints/surgery

KW - Fracture Fixation, Internal/methods

KW - Humans

KW - Patient Satisfaction/statistics & numerical data

KW - Postoperative Complications

KW - Treatment Outcome

U2 - 10.1016/j.injury.2020.04.005

DO - 10.1016/j.injury.2020.04.005

M3 - SCORING: Review article

C2 - 32299630

VL - 51

SP - 1258

EP - 1265

JO - INJURY

JF - INJURY

SN - 0020-1383

IS - 6

ER -