Operative treatment of Lisfranc injuries in elite athletes: 2024 International Foot and Ankle Sports Consensus and systematic review.

In 30 seconds

This Level V systematic review and modified Delphi consensus examined operative strategies for unstable Lisfranc injuries in elite athletes. Sixteen studies covering 406 athletes informed comparisons of suture button fixation (SBF), open reduction and internal fixation (ORIF), and arthrodesis. For unstable ligament injuries, SBF was associated with fewer complications and secondary procedures than ORIF: 10.9% vs. 18.2% and 0% vs. 30.5%, respectively. For fracture-dislocation injuries, ORIF and arthrodesis had similar complication and failure rates, while secondary procedures were more frequent after ORIF. The panel produced 16 statements, 12 with unanimous agreement.

Key findings

• For unstable ligament injuries, SBF versus ORIF had complication rates of 10.9% vs. 18.2%, with zero versus 4.9% failures.
• Secondary procedures for unstable ligament injuries occurred in 0% after SBF and 30.5% after ORIF; 93.5% of ORIF reoperations were for hardware removal.
• For fracture-dislocation injuries, ORIF versus arthrodesis had similar complication rates (30.8% vs. 35.5%) and failure rates (13.8% vs. 12.9%).
• The consensus process produced 16 statements: 12 achieved unanimous agreement and 4 achieved strong consensus.

Why it matters

Lisfranc injury patterns differ, and the review suggests that operative strategy may affect complications and the likelihood of further procedures. Its synthesis offers clinicians a framework for discussing fixation versus fusion in elite athletes, while emphasizing that joint-surface salvageability and individual injury characteristics matter. The evidence is based on a systematic review and expert consensus rather than high-level comparative trials.

What to keep in mind

The study is Level V evidence, and the review included 16 studies; the abstract does not report randomized comparisons.