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Adequate return to sports and sports activities after treatment of Lisfranc injury: a meta-analysis
  1. Carlijn S ter Laak Bolk1,2,3,
  2. Jari Dahmen1,2,3,
  3. Kaj T A Lambers1,2,3,
  4. Leendert Blankevoort1,2,3,
  5. Gino M M J Kerkhoffs1,2,3
  1. 1Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  2. 2Academic Center for Evidence-based Sports medicine (ACES), Amsterdam, The Netherlands
  3. 3Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
  1. Correspondence to Professor Gino M M J Kerkhoffs, Department of Orthopaedic Surgery, Amsterdam UMC - Location AMC, Amsterdam 1105 AZ, North Holland, The Netherlands; g.m.kerkhoffs{at}


Importance Although a large number of Lisfranc injuries occur during sports, data on sports outcomes, such as return to sport (RTS) rates and times as well as level of sports activities after treatment of this injury remain limited.

Objective The aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries.

Evidence review The electronic databases PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL were searched to identify relevant articles from January 1985 to July 2020. The mean RTS rates (to any level and preinjury level of sports) and times were extracted per study, and pooled wherever methodologically possible. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS).

Findings Fifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%).

Conclusions and relevance The different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries.

Level of evidence Systematic review and meta-analysis.

  • foot
  • outcome studies
  • sprains and strains

Statistics from


  • Contributors CStLB, JD and KTAL contributed to the conception, design and data collection of the study, performed the analysis and interpretation of all data and wrote the manuscript. LB and GMMJK contributed to the conception and the design of the review and contributed to the data collection and analysis of the study. LB and GMMJK also performed a third-party adjudication process and contributed to the writing of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KTAL has received research support from the Marti-Keuning Eckhardt Foundation.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data as analysed in the present study were gathered from publications on either PubMed (MEDLINE), EMBASE, CDSR, DARE or CENTRAL.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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