title: Clinical Outcomes and Development of Symptomatic Osteoarthritis 2 to 24 Years After Surgical Treatment of Tarsometatarsal Joint Complex Injuries.
abstract: BACKGROUND
  Injuries to the tarsometatarsal (TMT) joint complex, or Lisfranc injuries, have been reported to result in osteoarthritis (OA) following surgical treatment. Good outcomes with respect to short and medium-term results have been reported. However, long-term results, specifically regarding clinical outcomes and the development of symptomatic OA, are limited. The objectives of this study were to assess clinical outcomes, the occurrence of symptomatic OA, and risk factors for OA at 2 to 24 years after a Lisfranc injury treated surgically with open reduction and internal fixation (ORIF) or with primary arthrodesis.
  
  
  METHODS
  This was a retrospective study involving 61 patients treated surgically at our institution between 1988 and 2009 for an injury to the TMT joint complex. Patients underwent either ORIF with transarticular screws or primary arthrodesis when joint comminution at the TMT level was such that ORIF was not possible. Functional outcomes were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot Function Index (FFI), and a visual analog scale (VAS) for pain. Global health was evaluated with the Short Form (SF)-12 Health Survey physical component summary (PCS).
  
  
  RESULTS
  Sixty-one of the 128 patients were available for clinical evaluation, including the use of questionnaires, and radiographic assessment at a mean of 10.9 years postoperatively (range, 2.4 to 23.9 years). Mean scores were as follows: AOFAS score, 79.0; FFI, 16.9, and VAS for pain, 2.5. Radiographic evidence of OA was noted in 44 (72.1%) of the patients, and symptomatic OA, in 54.1%, the latter having worse outcomes. Risk factors for OA were nonanatomic reduction, fracture classification of Myerson type C, and a history of smoking.
  
  
  CONCLUSIONS
  Two to 24 years following surgical treatment to restore and maintain joint anatomy for Lisfranc injuries, we found satisfactory clinical outcome scores and a large number of patients who had returned to their previous level of functioning and employment, with little need for secondary procedures. However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland victor.dubois-ferriere@hcuge.ch.
authors.forename: Victor
authors.initials: V
authors.lastname: Dubois-Ferrière
authors.affiliation: Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.affiliation: Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Chowdhary
authors.affiliation: Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
authors.affiliation: Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Dennis
authors.initials: D
authors.lastname: Dominguez
authors.affiliation: Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000009:adverse effects*; D001863:Bone Screws; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult