Back in Action: High Return to Pre-Injury Level of Sports after Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the First Metatarsophalangeal (MTP-1) Joint.

OBJECTIVE: The primary aim was to assess the return to sports outcomes of patients with symptomatic osteochondral lesions (OCLs) to the first metatarsophalangeal (MTP-1) joint treated by arthroscopic bone marrow stimulation (BMS). Secondary aims were to present patient-reported outcome measures (PROMs) on pain scores as well as surgery-related complications or reoperations to the MTP-1 joint. DESIGN: All patients with MTP-1 OCLs treated by arthroscopic BMS with a minimum follow-up of 12 months were included. Outcomes included return to sports and work outcomes, satisfaction outcomes with the performed treatment, PROMs, as well as postoperative complications and reoperations. Medical records were screened by 2 independent reviewers and patients were contacted by phone to partake in an in-depth interview. Complications, reoperations, and revision surgeries were additionally assessed. RESULTS: Nine patients (median age: 22 years with interquartile range (IQR) 20-29 years) were included with a median follow-up time of 47 (IQR: 23-92) months. Six (86%) out of 7 patients who participated in sports preoperatively returned to sports at any level at a median of 4 (IQR: 2.6-5.8) months. Five patients (71%) returned to pre-injury level of sport and eventually returned to performance at a median of 4 (IQR 2.8-7.5) and 8 (IQR: 4.0-10.5) months, respectively. The median Numeric Rating Scale for pain during walking was 1 (IQR 0-2.5) and all (100%) patients were able to return to work at a median of 4 (IQR: 2-17) weeks. Eighty-nine percent of the patients were very or fairly satisfied with the result of their treatment. No complications, reoperations, or revision surgeries were reported. CONCLUSIONS: Arthroscopic BMS for patients with symptomatic OCLs to the MTP-1 joint can be considered safe and yields an 86% return to sport at any level and a 71% return to pre-injury and performance level, with good clinical, return to work, as well as satisfaction outcomes.

Adequate return to sports and sports activities after treatment of Lisfranc injury: a meta-analysis.

IMPORTANCE: Although a large number of Lisfranc injuries occur during sports, data on sports outcomes, such as return to sport (RTS) rates and times as well as level of sports activities after treatment of this injury remain limited. OBJECTIVE: The aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries. EVIDENCE REVIEW: The electronic databases PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL were searched to identify relevant articles from January 1985 to July 2020. The mean RTS rates (to any level and preinjury level of sports) and times were extracted per study, and pooled wherever methodologically possible. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS). FINDINGS: Fifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%). CONCLUSIONS AND RELEVANCE: The different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries. LEVEL OF EVIDENCE: Systematic review and meta-analysis.