Distal chevron osteotomy versus different operative procedures for hallux valgus correction: a meta-analysis

Abstract

Introduction: Distal chevron osteotomy is commonly used for the operative treatment of hallux valgus (HV). However, there are several operative procedures that can be used to treat HV. The aim of this meta-analysis was to compare the efficacy of distal chevron osteotomy with different operative procedures.

Materials and methods: A systematic search was conducted using the MEDLINE and EMBASE databases to identify randomized clinical trials (RCTs). The variables were radiological (hallux metatarsal phalangeal angle [HVA] and intermetatarsal angle [IMA]) and clinical (American Orthopaedic Foot & Ankle Society Score [AOFAS]). Heterogeneity was assessed with chi² and I² statistics. A random effects model was used for significant heterogeneity. Publication bias was evaluated with funnel plots.

Results: Ten studies involving 985 patients were evaluated in the meta-analysis. Distal chevron osteotomy was associated with a mean IMA correction 2.18° greater than the scarf procedure (MD - 2.18; 95% CI - 3.67, - 0.69; p = 0.004; I² = 0%). In addition, the proximal chevron was associated with a mean IMA correction 1.08° greater than the distal chevron (MD - 1.08; 95% CI - 1.86, - 0.29; p = 0.007; I² = 0%). The AOFAS assessment showed an overall advantage of 3.2 points in favor of the Lingdren group compared with distal chevron osteotomy (MD 3.20; 95% CI 0.37, 6.04; p = 0.03; I² = 0%).

Conclusions: Our findings indicate that distal chevron osteotomy provides a greater HVA correction than scarf osteotomy, and proximal chevron provides a larger IMA correction than distal chevron osteotomy. Lingdren osteotomy provides a greater AOFAS correction than distal chevron osteotomy.

Level of evidence: Level I, meta-analysis.

Keywords: Chevron osteotomy; Distal chevron; Hallux valgus; Meta-analysis.

Fig. 1

Study selection flow diagram (Preferred Reporting Items for Systematic Reviews and Meta-Analysis): The PRISMA diagram showing the exclusion and inclusion strategy of randomized clinical trials on distal chevron osteotomy of hallux valgus

Fig. 2

Risk of bias summary (Green: low risk; white: unknown risk; red: High risk)

Fig. 3

Forest plot of Hallux Valgus Angle: a HVA correction between distal chevron and scarf; b HVA correction between distal chevron and Lindgren; c HVA correction between distal chevron and proximal chevron

Fig. 4

Hallux Valgus Angle funnel plot diagrams: a Distal chevron versus scarf; b Distal chevron versus Lindgren; c Distal chevron versus proximal chevron

Fig. 5

Forest plot of Inter Metatarsal Angle: a IMA correction between distal chevron and scarf; b IMA correction between distal chevron and Lindgren; c IMA correction between distal chevron and proximal chevron

Fig. 6

Inter Metatarsal Angle funnel plot diagrams: a Distal chevron versus scarf; b Distal chevron versus Lindgren; c Distal chevron versus proximal chevron

Fig. 7

Forest plot of AOFAS scale: a AOFAS correction between distal chevron and Lindgren; b AOFAS correction between distal chevron and proximal chevron

Fig. 8

AOFAS funnel plot diagrams: a Distal chevron versus Lindgren; b Distal chevron versus proximal chevron