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

Background: Operative intervention to achieve accurate anatomic reduction for unstable ligamentous Lisfranc joint injuries in athletes is recommended for good outcomes, although open reduction and internal fixation (ORIF) compared with 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. Purpose: To evaluate outcomes of retaining metalwork after ORIF for acute isolated ligamentous Lisfranc injuries in a cohort of professional elite athletes, focusing on complications such as metalwork breakage, reoperation, and expected return to sports (RTS) time. Study Design: Case series; Level of evidence, 4. Methods: A total of 32 elite athletes (mean follow-up, 40.6 months [range, 26-58 months]) with acute isolated ligamentous Lisfranc injuries treated with ORIF using the extra-articular dorsal bridge-plating technique were evaluated. Removal of metalwork was not planned routinely unless symptomatic. Descriptive data, time to RTS, player status at the last visit, and complications specific to metalwork retention were analyzed and reported. Results: All 32 athletes had a diastasis of >2 mm, categorized as Nunley and Vertullo type 2 injuries. The mean 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 = .09) when compared with rugby players. Four athletes (12.5%) required removal of metalwork at a mean of 8.5 months postoperatively. Three cases were due to screws backing out and 1 case had a broken screw with pain across the plate region. There were 3 additional patients with broken screws that were left in situ, as the patients were asymptomatic and still playing competitively. Two other athletes required conversion to arthrodesis because of painful midfoot arthritis at 16 months and 35 months after fixation, respectively. Despite that, all these athletes returned to their professional career at their last review. Conclusion: Retention of metalwork after 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.