Outcomes following Surgical Treatment for Symptomatic Accessory Navicular: A Systematic Review

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to examine the clinical and radiological outcomes of various surgical treatments for symptomatic accessory naviculars. Methods: During February 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical treatment for symptomatic accessory navicular. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analyzed. 26 studies were included for review. Results: In total, 520 patients (614 feet) underwent surgical treatment for the management of symptomatic accessory navicular. The weighted mean age was 28.18 ± 8.18 and the weighted mean follow-up time was 46.23 ± 34.76 months. The mean AOFAS score was 49.9 ± 7.39 preoperatively and 88.9 ± 5.61 postoperatively. The mean complication rate at final follow-up was 9.02% and the failure rate was 4.23%, with only 2.7% of patient ultimately requiring a further procedure. We also compared outcomes in patient who underwent a Kidner or Modified Kidner procedure (n=245) with those treated with a different surgical technique such as fusion or simple excision (n=275). There was no significant difference in outcome scores, complication rates, failure rates, or secondary surgical procedure rates between these cohorts. Conclusion: This systematic review demonstrated improvement in clinical outcomes following surgical treatment for symptomatic accessory naviculars. The markedly low complication and failure rates further indicate that surgical intervention is beneficial in the management of symptomatic accessory naviculars. Kidner and Modified Kidner procedures resulted in equivocally good outcomes compared with other surgical approaches such as fusion and simple excision. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions for optimal surgical technique. Further research is warranted to determine whether the Kidner procedure confers any particular advantages over other approaches.