Summary

Our study found that there was a 81.8% return to play rate for NFL athletes sustaining Lisfranc injuries, with a significant decrease in performance one-year post-injury.

Abstract

Purpose

A Lisfranc injury can occur to either the ligament or bone, which causes instability when attempting to perform strength and balance maneuvers. The purpose of this study was to analyze the return to play (RTP) and performance level of players following Lisfranc injury in the National Football League (NFL). We hypothesized that there would be a low return to play following Lisfranc injury in the NFL. Secondarily, the economic and financial impact of Lisfranc injuries in the NFL will be determined.

Methods

Multiple online public records were used to identify NFL players with Lisfranc injuries between the 2009 and 2020 seasons. Players were assessed for their return to play statistics – games played, games started, snap counts and approximate value (AV). Non-parametric methods were used to compare player statistics before and after injury. Also, salaries while injured were calculated to approximate economic loss for players who returned to play, adjusted for inflation.

Results

A total of 33 NFL athletes sustained a Lisfranc injury during the 2009 and 2020 seasons. 81.8% (27 of 33) of players returned to play after their injury. Most of the Lisfranc injuries were experienced by offensive linemen (8, 24.2%), followed by running backs (7, 21.2%). The median RTP time was 11.0 months (interquartile range [IQR]: 10.2 – 11.8 months). There were not significant differences between the pre- and post-injury number of games played, started, or snaps counts. In terms of player performance, there was a statistically significant decrease in AV during the return year following injury [median 6.0 (IQR: 4.0–10.0) vs. 5.0 (2.5–7.5); p=0.022]. Cost of recovery (COR) amounted to $104.7 million, with quarterbacks accounting for the greatest loss at $32.6 million (n=4). The next two most expensive positions were offensive and defensive linemen at $19.4 million each (n=5 each).

Conclusion

Our results do not support the hypothesis, as it was found that 81.8% RTP rate for NFL athletes sustaining Lisfranc injuries. This injury is associated with a significant decrease in AV one-year post-injury. In terms of economic impact, quarterbacks accounting for almost 1/3 of expenses while only constituting 14.8% of injuries due to their higher average salary.