Is Age a Determining Factor When Considering Arthrodesis in LisFranc Injuries? A Retrospective Cohort Analysis with Patient Reported Outcomes
Authors: De Leon Ryan , Sharma Akhil , Malige Ajith , Lachman James R. 
Published: December 2023

Category:

Trauma; Midfoot/Forefoot

Introduction/Purpose:

The debate between primary arthrodesis and open reduction and internal fixation(ORIF) of LisFranc injuries continues. Most of the available literature focuses on radiographic and clinical outcomes and fails to add the patient perspective to the analysis. A small number of high-quality studies have suggested superiority of arthrodesis over ORIF in certain patient populations but, thus far, age has not been analyzed as an independent variable. Some studies mention an aversion to performing arthrodesis in young patients but no evidence is available to support this claim. In this study, we analyze the effects of age on patient reported, clinical, and radiographic outcomes in LisFranc injuries.

Methods:

In this IRB approved study, a retrospective analysis of prospectively collected data was conducted on 108 patients with a mean age of 44.6 +/- 16 years who underwent either arthrodesis or ORIF for a LisFranc injury. All patients who underwent surgery between January 2016 and January 2022 were included in the analysis. Patients were excluded if they were younger than 18, did not meet the minimum follow-up duration of 3 months, and did not have both preoperative and postoperative patient reported outcome scores. Two age categories were created based on the median age of the cohort (18-40 years old and then 40- 81 years old) and analysis was performed based these age categories. Adaptive PROMIS Depression, Physical Function, and Pain interference scores were collected. Clinical and radiographic analysis was performed using the electronic medical record and PACs system. All statistical analysis was performed by someone with an expertise in statistics.

Results:

163 patients who underwent either procedure during the time period were identified but 55 patients were excluded due to incomplete data or being underage. 61 patients (average age 44.7 +/-13) underwent ORIF and 47 patients (46.1 +/-16) underwent arthrodesis for LisFranc injuries. Within the ORIF cohort 25 (41%) were 18-40 years old and within the arthrodesis cohort 19 (40%) we 18-40 years old. No differences were observed between the two groups with regard to quality of reduction, complications, or PROMIS data. Anatomic or acceptable reduction was achieved in 92% of the ORIF cohort and 96% of the arthrodesis cohort. There was an increased rate of hardware removal in the ORIF group. See the attached table for complete results.

Conclusion:

In this study, age was not a predictor of outcomes after Lisfranc surgery whether performing an ORIF or an arthrodesis. Outcomes, both clinical and patient reported, for young patients in this cohort did not differ statistically regardless of whether the patient underwent ORIF or arthrodesis. The results of this study suggest that younger age should not deter a surgeon from arthrodesis if this is the procedure felt to be most appropriate in a given injury. Anatomic reduction led to consistently good patient reported outcomes regardless of surgical technique used.