Studies directly comparing Lisfranc injuries treated with primary arthrodesis or open reduction and internal fixation show no significant difference in return to sport and complications: A systematic review and meta-analysis

Lisfranc injuries are common and can cause sport-ending morbidity. Management through primary arthrodesis (PA) or open reduction and internal fixation (ORIF) is a subject of debate. PubMed, EMBASE, and the Web of Science databases were queried for studies assessing return to sport (RTS) outcomes following treatment of Lisfranc injuries with PA or ORIF. RTS rates, time to RTS, and complication rates were assessed. Maximum likelihood random-effects models were created based on comparative studies to evaluate differences in RTS and complication rates with odds ratios representing pooled estimates. Heterogeneity of return to sport outcomes was explored with sub-analysis of athlete level (non-elite vs. elite) and type of fixation. Across 23 studies, 603 Lisfranc injuries were identified; 498 underwent ORIF and 105 received PA. Return to sport ranged from 65 to 100 % in ORIF subjects and 67-100 % of PA subjects. Meta-analysis of comparative studies reveals no significant difference in likelihood of RTS or complications (p = 0.44 I2=26 %; p = 0.93 I2=0 %, respectively). RTS times range from 8 to 30 weeks for ORIF and 19.7-28.5 weeks for PA. Studies assessing RTS following ORIF and PA for Lisfranc injuries are heterogeneous, yet pooled data from comparative evidence suggests no significant difference in likelihood of RTS or complications. PA and ORIF have the potential for successful RTS though further prospective randomized studies are needed to better counsel athletes regarding the ideal surgical management for patient goals.