Return to sport following Lisfranc injuries in elite athletes—2024 international foot and ankle sports consensus and systematic review

Purpose Lisfranc injuries, also referred to as tarsometatarsal joint injuries, are relatively uncommon within the general population and can possess profound clinical implications, especially for elite athletes. Existing follow-up and return to sport (RTS) protocols remain poorly defined and variable based on surgeon preference or institutional protocols. The purpose of this study was to both perform a systematic review and determine if consensus on postoperative protocols and RTS timelines could be reached among an expert panel of orthopaedic foot and ankle surgeons who manage Lisfranc injuries in the elite athlete.Methods The systematic review evaluated the post-operative management of sports-related Lisfranc injuries. A consensus process was then conducted using a modified Delphi technique with four rounds of questionnaires. General consensus was defined as 75%-85% agreement, strong consensus as 86%-99% agreement and unanimous consensus as 100% agreement.Results The systematic review found patients with ligament Lisfranc injuries were permitted to begin weightbearing at an average of 3.5 weeks. The mean time for these athletes to RTS was 8.9 months. Those with bony Lisfranc injuries were allowed to partially weightbear at 4.5 weeks, on average. Bony Lisfranc injuries treated with open reduction and internal fixation (ORIF) allowed the athlete to RTSs at a median of 8 weeks (range 3-12 weeks). There are nine consensus statements presented that illustrate the expected follow-up and RTS milestones. There was unanimous agreement that the athlete can expect to return to their sport 4-6 months postoperatively and athletes with unstable ligament injuries can expect to return to full weightbearing 8-12 weeks postoperatively.Conclusions This study integrates expert consensus and systematic review findings to establish evidence-based guidelines for returning athletes to sport following Lisfranc injuries. Consensus and literature findings aligned, indicating that most athletes progress to full weightbearing by 8-12 weeks and RTS within 4-6 months postoperatively. Over 90% of athletes successfully resumed play, underscoring the effectiveness of structured, phase-based rehabilitation. These data provide a standardised framework to guide clinicians in optimising recovery and ensuring a safe, efficient RTS.Level of Evidence Level V.