Patient Reported Outcomes Following Surgical Intervention of Isolated Lisfranc Injury: Minimum Two- year Follow-up

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: This is the largest cohort to date of patients who completed the patient reported outcome measurement information systems (PROMIS) along with the foot function index (FFI) following operative fixation for Lisfranc injury. The patient outcomes were compared against the mean population with inter-analysis comparing varying operative procedures used, basic demographic information, and patient comorbidities and their individual impact on PROMIS, FFI and VAS scores. Methods: 131 patients between 2010 and 2020 met inclusion criteria and were selected for this study. Utilizing the electronic medical record (EMR), patient charts were reviewed to obtain basic patient demographic information and comorbidities. Operative reports were reviewed to determine which procedure or combination of procedures was performed for definitive fixation. VAS scores were obtained from patients preoperatively and at two, six, and twelve weeks post-operatively. PROMIS and FFI scores were obtained via phone calls and when reviewing patient charts. The impact of categorical variables on complications was compared using Chi-Squared tests. Variables were analyzed with a type 3 SS ANOVA test to stratify independent risk factors on PROMIS, FFI and VAS scores and to account for confounding variables. Results: Arthrodesis procedure (p=.025) was associated with a significant decrease in complication rates. Males, HR screw placement, and arthrodesis were independent risk factors for significantly higher reports of PROMIS pain interference, FFI disability, and FFI activity limitation. Males, alcohol consumption, and those treated with arthrodesis had higher FFI pain scores (p=0.0193, p=.0498, and p=0.0351). ORIF was found to be an independent risk factor for significantly increased PROMIS physical function (p=0.046), whereas bone grafting during the procedure was associated with lower PROMIS depression scores (p=0.0096). Tobacco use at the time of operation and arthrodesis were independent risk factors for higher FFI total scores (p=0.0153 and p- 0.0273). Patient’s preoperative VAS score averaged 5.13. Postoperative VAS scores averaged 3.89, 2.65 and 2.04 for two, six and twelve respectively (p < 0.001). Conclusion: Patient reported outcomes following Lisfranc surgery reported via PROMIS, FFI and VAS scores are independently influenced by patient demographics, comorbidities, and surgical variables. Analysis of potential associations between these patient characteristics and PROMIS and FFI scores provides evidence for physicians to manage patient expectations prior to operative treatment of a non-polytraumatic Lisfranc injury.