Lisfranc injury: Prevalence and maintaining a high index of suspicion for optimal evaluation

To quantify the long-term prevalence of game-related Lisfranc trauma in college football on artificial turf and natural grass.

32 universities were evaluated over 10 competitive seasons across all Football Bowl Subdivision (FBS) conferences. Outcomes of interest included injury severity, injury category, primary type of injury, player and skill position, injury mechanism and situation, elective imaging and surgical procedures, and field conditions. Injury incidence rates (IIR) were calculated using injuries per 10 games = (number of injuries) number of games) × 10.

Of the 1577 games documented, 783 games (49.7%) were played on a 3-layer artificial turf (≥9.0 lbs/ft²) infill system versus 794 games (50.3%) played on natural grass. In sum, 78 Lisfranc cases were documented with 34 (43.6%) occurring on artificial turf, and 44 (56.4%) on natural grass. MANOVAs indicated significant main effects by injury category (F_3,74 = 6.439; P = .001), and injury mechanism (F_5,72 = 3.372; P = .009) observed between surfaces, but not by injury severity (F_2,75 = 0.720; P = .490), primary type of injury (F_4,73 = 0.772; P = .547), overall player (F_2,75 = 0.219; P = .804) and skill positions (F_8,69 = 0.850; P = .563), injury situation (F_10,67 = 1.030; P = .428), elective imaging and surgical procedures (F_3,74 = 0.515; P = .673), or field conditions (F_2,75 = 0.375; P = .688). Post hoc analyses indicated significantly greater incidences (P < .05) of Lisfranc trauma on natural grass attributed to shoe:surface interaction during noncontact play, and during no contact, foot rotation or planting. Ligament tears (n = 8; 57.1%), with minimal cases of subluxation/dislocations (n = 4; 28.6%) and fractures (n = 2; 14.3%) comprised grade 3 cases across both surfaces.

In regards to Lisfranc trauma, a 3-layer, heavyweight artificial infill surface is as safe or safer than natural grass. The findings of this study may be generalizable only to this level of football competition.