Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes.
Scott D Semelsberger, Vanessa J Boggiano, Kassidy Webber et al.
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In 30 seconds
This Level V expert consensus and systematic review addressed diagnosis and nonoperative management of Lisfranc injuries in elite athletes. A modified Delphi process involved 32 international orthopaedic foot and ankle surgeons, alongside review of clinical studies reporting athletic outcomes. Experts supported bilateral weight-bearing radiographs initially and CT or MRI when low-grade instability is suspected. Stable, nondisplaced injuries with intact ligaments on MRI were considered suitable for monitored nonoperative care. In the reviewed studies, 96.8% of athletes with ligament injuries returned to sport, at 2.8 months versus 4.5 months for bony injuries.
Key findings
- Seven consensus statements were unanimous and six were strong, covering injury recognition, imaging and nonoperative management.
- Initial imaging consensus favored bilateral weight-bearing radiographs; CT or MRI was advised for suspected low-grade instability.
- Experts supported nonoperative care with close monitoring for stable, nondisplaced injuries with intact ligaments on MRI.
- Return to sport was reported in 96.8% of athletes with ligament injuries, at 2.8 months versus 4.5 months for bony injuries.
Why it matters
Lisfranc injuries can be difficult to identify in athletes, particularly when instability is subtle, while return-to-sport demands make management consequential. The consensus offers a structured approach to clinical suspicion, examination and imaging, and distinguishes stable injuries that may be monitored without surgery from unstable or displaced injuries for which the abstract describes surgical fixation.
What to keep in mind
The evidence level is V, and the recommendations combine expert consensus with a systematic review of clinical studies; the abstract does not report the number or quality of included studies.