Outcomes following Open vs Minimally Invasive Chevron Osteotomy for the Management of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review and meta-analysis is to compare outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICA) for the management of hallux valgus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICO) for the management of hallux valgus deformity. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 6 comparative studies were included in this review. Results: In total, 183 patients (208 feet) underwent OCO and 209 patients (244 feet) MICA for the management of hallux valgus deformity. Meta-analysis demonstrated no difference in post-operative MOFXQ scores (SMD: 0.0849, [-0.2584, 0.4282], p = 0.6277), hallux valgus angle (SMD: -0.1245, [-0.4204, 0.1715], p = 0.4099), intermetatarsal angle (SMD:-0.2565, [-0.5539, 0.0408], p = 0.909) and failures (RR: 1.0765, [0.0993, 11.6760], p = 0.9278) between the OCO cohort and the MICO cohort. There was a lower complication rate in the OCO cohort compared to the MICO cohort (RR: 0.2614, [0.1453, 0.4704], p < 0.0001). Conclusion: This systematic review found comparable improvements in subjective clinical outcomes, functional outcomes and radiographic outcomes following both OCO and MICO at short-term follow-up. However, a lower RR with respect to complications was found in the OCO cohort compared to the MICO cohort. Despite the significant heterogeneity across the included studies, the similar outcomes between the 2 cohorts reinforces that further research is warranted to determine the optimal role of OCO and MICO in the management of hallux valgus deformity.