2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Routine Retention of Metalwork Following Extra-Articular Dorsal Plate Fixation of Ligamentous Lisfranc Injuries in Elite Athletes Enables Early Return to Sports

Choon Chiet Hong, MBBS, MMed (Ortho), MPH, FRCSEd (Orth), Singapore, Singapore SINGAPORE
James D. Calder, OBE, MBBS, MD, PhD, FRCS, FFSEM(UK), London UNITED KINGDOM

Fortius Clinic, London, England, UNITED KINGDOM

FDA Status Cleared

Summary

Routine retention of metalwork following extra-articular dorsal plate fixation of ligamentous Lisfranc injuries in elite athletes enables early return to sports

Abstract

Introduction

Operative intervention to achieve accurate anatomical reduction for unstable ligamentous Lisfranc joint injuries in athletes is recommended for good outcomes although open reduction and internal fixation (ORIF) compared to primary arthrodesis is still debated. In addition, there is also no consensus on whether metalwork should be routinely removed or retained after Lisfranc joint ORIF. Hence, we aim to evaluate outcomes of retaining metalwork after ORIF for acute isolated ligamentous Lisfranc injuries in a cohort of professional elite athletes focussing on complications such as breakage of metalwork, reoperation and expected time of return to sports.

Methods

32 elite athletes with acute isolated ligamentous Lisfranc injuries treated with ORIF using the extra-articular dorsal bridge-plating technique with an average follow-up of 40.6 months (range 26–58 months) were evaluated. Removal of metalwork was not planned routinely unless symptomatic. Demographic details, time to return to sport, player status at last visit and complications specific to metalwork retention were analysed and reported.

Results

All 32 athletes had a diastasis of > 2mm categorized as Nunley and Vertullo type 2 injuries. The average time of return to their preinjury level of sports was 18.7 weeks (range 14–25 weeks). Soccer players returned to their sport significantly earlier (17.3 weeks vs 19.9 weeks; p=0.09) when compared to rugby players. Four athletes (12.5%) required removal of metalwork at an average of 8.5 months postoperatively. Three cases were due to screws backing out and one case had a broken screw with pain across the plate region. There were three further patients with broken screws which were left in situ as they were asymptomatic and still playing competitively. Two other athletes required conversion to arthrodesis due to painful midfoot arthritis at 16 months and 35 months post-fixation respectively. Despite that, all these athletes returned to their professional career at their last review.

Conclusion

Retention of metalwork following extra-articular dorsal bridge-plating ORIF for acute isolated ligamentous Lisfranc injury in elite athletes enables return to preinjury sporting level without significant mechanical complications and selective removal of metal may be considered if symptoms arise.