An independent librarian from Maastricht University checked the search strategy for errors. No restrictions were applied to this search. Two authors (NACB, AJLL) independently searched the PubMed, CENTRAL, EMBASE, CINAHL, PEDro, and SPORTDiscus databases. NRCT, non-randomized controlled trial ORIF, open reduction and internal fixation PA, primary arthrodesis PROM, patient-reported outcome measure RCT, randomized controlled trial. ![]() The inclusion and exclusion criteria are summarized in Table I. Is ORIF or PA a better operative treatment option for Lisfranc injuries, based on PROMs reported in the currently published literature? The outcome measures of this review are PROMs, and risk of secondary surgeries. 17 Research question and inclusion and exclusion criteria The Preferred Reporting Items for Systematic review and Meta-analysis (PRISMA) guidelines were followed in conducting and reporting this review. Our systematic review and meta-analysis aims to draw a conclusion about the best available treatment, based on the most complete and recent evidence regarding PROMs and risk of secondary operations. The most frequently used PROM is the AOFAS, although the Short-form 36 (SF-36) score and Visual Analogue Scale (VAS) are also used frequently. Postoperative pain and secondary surgeries all have an effect on patients’ wellbeing, and PROMs provide good insights into these factors. 15, 16 Our systematic review and meta-analysis also included cohort series that reported on either ORIF or PA, to further substantiate any results found in the meta-analysis of the included comparative studies. 3, 9- 14 After these reviews, two studies on ORIF and PA have recently been published of which one RCT. However, these reviews reported a lack of power to support their findings, so it remains debatable which treatment is superior. They all reported no significant differences in patient-reported outcome measures (PROMs) like the American Orthopaedic Foot and Ankle Society (AOFAS) score. 6- 8Ī number of meta-analyses and reviews have already been published comparing ORIF with PA in Lisfranc injuries. 4, 5 However, more recent studies have reported good patient-reported outcomes after arthrodesis as primary treatment. 4 Traditionally, arthrodesis of the midfoot was seen as a salvage procedure for complicated outcome of Lisfranc injuries. 3 The generally accepted two operative techniques generally accepted are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). 1, 2 To date, it is unclear what the best operative treatment is for unstable Lisfranc injuries. Surgeons face a major challenge when treating patients with Lisfranc injuries. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making.Ĭite this article: Bone Jt Open 2021 2(10):842–849. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. ResultsĪ total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). The random and fixed-effect models were used for the statistical analysis. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Additionally, ongoing trial registers and reference lists of included articles were screened. MethodsĪ systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. ![]() ![]() The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery.
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