title: Epidemiology and Outcomes of Lisfranc Injuries Identified at the National Football League Scouting Combine.
abstract: BACKGROUND
  Lisfranc injuries are challenging to treat and may have a detrimental effect on athletic performance.
  
  
  OBJECTIVE
  (1) Determine the epidemiological characteristics of Lisfranc injuries at the annual National Football League (NFL) Scouting Combine, (2) define player positions at risk for these injuries, and (3) evaluate the impact that these injuries and radiographic findings have on NFL draft position and performance.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  All players who sustained a Lisfranc injury prior to Combine evaluation between 2009 and 2015 were evaluated. The epidemiological characteristics, player positions affected, treatment methods, and number of missed collegiate games were recorded. Radiographic outcomes were analyzed via Combine radiograph findings, while NFL performance outcomes were assessed for all Lisfranc injuries (2009-2013) compared with matched controls in the first 2 years of play.
  
  
  RESULTS
  A total of 41 of 2162 (1.8%) Combine participants were identified with Lisfranc injuries, of whom 26 of 41 (63.4%) were managed operatively. Players who underwent surgery were more likely to go undrafted compared with players managed nonoperatively (38.5% vs 13.3%, operative vs nonoperative management, respectively; P = .04) and featured a worse NFL draft pick position (155.6 vs 109; P = .03). Lisfranc-injured players when compared with controls were noted to have worse outcomes in terms of NFL draft position (142 vs 111.3, Lisfranc-injured players vs controls, respectively; P = .04), NFL career length 2 years or longer (62.5% vs 69.6%; P = .23), and number of games played (16.9 vs 23.3; P = .001) and started (6.8 vs 10.5; P = .08) within the first 2 years of their NFL career. Radiographs demonstrated that 17 of 41 (41.5%) athletes had residual Lisfranc joint displacement greater than 2 mm compared with the contralateral foot. Lisfranc-injured athletes with greater than 2 mm residual displacement, when compared with matched controls, had worse draft position (156.9 vs 111.2 for Lisfranc-injured players vs controls, respectively; P = .009) and fewer games played (14.4 vs 23.3; P = .001) and started (3.1 vs 10.5; P = .03). Moreover, athletes with greater than 2 mm residual displacement featured worse outcomes across all assessed NFL variables versus athletes with residual displacement of 2 mm or less.
  
  
  CONCLUSIONS
  Lisfranc injuries identified at the NFL Combine have an adverse effect on an NFL athlete's draft status, draft position, and overall play during initial NFL seasons. In particular, residual displacement of the Lisfranc joint has a detrimental effect on the first 2 seasons of NFL play and may lead to long-lasting negative effects on the athlete's career.
authors.affiliation: Penn Orthopaedics, Cape Regional Physicians Associates, Cape May Court House, New Jersey, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: McHale
authors.affiliation: Sports Medicine & Performance Center, University of Kansas Hospital, Kansas City, Kansas, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Vopat
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: Brendin R
authors.initials: BR
authors.lastname: Beaulieu-Jones
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: George
authors.initials: G
authors.lastname: Sanchez
authors.affiliation: New England Patriots, Foxborough, Massachusetts, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Whalen
authors.affiliation: Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: McDonald
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: DiGiovanni
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Theodore
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.|The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Provencher
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D054874:Athletic Performance; D015331:Cohort Studies; D018409:Foot Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005538:Football / Q000293:injuries* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Lisfranc; NFL; football; tarsometatarsal joint