Introduction

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

Data was collected from the NFL Combine on all participating players who had sustained a Lisfranc injury before entering the NFL between 2009 and 2015. Medical records, imaging, and treatments were reviewed on all individuals who met these criteria. The epidemiology of Lisfranc injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player, as well as examination and imaging findings. Players from 2009 to 2013 with a Lisfranc injury were compared to matched controls. Control groups consisted of players who missed less than 2 games in college, played the same position, and did not have a previous surgery or documented injury. NFL performance outcomes were evaluated through analysis of draft position, career length greater than or equal to 2 years, and number of games played and games started within their first 2 years (STATS.com). Two-sample, two-tailed T-tests were computed to assess games missed in college and draft position in players with a Lisfranc injury and NFL career consisting of games played, and started in the NFL in the first 2 years of their career versus control players.

Results

Forty-one (1.8%) players at the NFL Scouting Combine had a history of a Lisfranc injury that resulted in a mean 2.9±4.9 missed games during their collegiate football career. Of the players who sustained this injury, 26 (63.4%) underwent surgical intervention. The number of missed collegiate games (4.3 vs. 0.5, p<0.01), percentage of players undrafted (38.5% vs. 13.3%, p=0.04) and overall draft position (155.6 vs. 109, p=0.03) were each significantly increased in the surgical versus non-operative groups. Analysis of radiographs of participants with a history of Lisfranc injury revealed 17 (41.5%) athletes with a residual Lisfranc joint displacement of >2 mm more than the contralateral uninjured foot. Lisfranc-injured athletes with >2 mm residual Lisfranc joint displacement were noted to have missed less collegiate games (1.2 vs. 4.2, p=0.03), but had a worse overall NFL draft position (156.9 vs. 116.6, p=0.06) and lower number of NFL games started (3.1 vs. 10, p=0.06) compared to those with <2 mm residual displacement.

Discussion And Conclusion

Lisfranc injuries, particularly those requiring surgical intervention, may compromise an athlete's ability to perform at the professional level, as shown by a decline in overall NFL draft position and decrease in number of NFL games played compared to uninjured controls. Earlier return to play following Lisfranc injury is associated with an increased risk for residual Lisfranc joint displacement. Maintaining anatomic reduction of the Lisfranc joint may optimize athletic performance, as residual displacement <2 mm is associated with improved NFL draft position and an increase in number of NFL games started.