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Review
. 2025 Nov 25:S1268-7731(25)00267-X.
doi: 10.1016/j.fas.2025.11.010. Online ahead of print.

Minimally invasive chevron osteotomy provides comparable outcomes to open surgery for hallux valgus: A systematic review and meta-analysis

Alexander Tham  1 , Jared Rubin  1 , Eve Lowton  1 , Ragul Rajivan  1 , James J Butler  1 , Nathaniel P Mercer  1 , Bradley A Lezak  1 , John G Kennedy  2
Affiliations
Review

Minimally invasive chevron osteotomy provides comparable outcomes to open surgery for hallux valgus: A systematic review and meta-analysis

Alexander Tham et al. Foot Ankle Surg. .

Abstract

Background: Minimally invasive surgery (MIS) chevron osteotomy has emerged as an alternative to the traditional open chevron (OC) osteotomy for hallux valgus correction, aiming to achieve similar deformity correction with reduced soft-tissue trauma and faster recovery. However, the relative clinical and radiographic outcomes of these techniques remain debated.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane databases were searched through June 2025 for randomized controlled trials (RCTs) and cohort studies comparing MIS and OC osteotomies in patients with hallux valgus. Only studies explicitly describing a percutaneous, burr-based V-shaped Chevron osteotomy were included. Primary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) pain scores, radiographic parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) and complication rates. Random-effects meta-analyses were performed, with subgroup analyses at early (≤6 months), mid-term (6-12 months), and long-term (>12 months) follow-ups.

Results: Six studies (3 RCTs, 1 prospective, 2 retrospective) comprising 342 patients (352 feet) were included. MIS chevron osteotomy demonstrated no significant differences compared with OC in postoperative AOFAS, VAS scores, HVA correction, or DMAA correction at any follow-up. Early postoperative VAS scores favored MIS, while postoperative and corrected IMA values at selected time points favoured open Chevron. However, all differences were small in magnitude and unlikely to be clinically meaningful. Complication rates were comparable between the techniques (OR 2.10, 95 % CI 0.82-5.40, p = 0.12, I2=23 %).

Conclusion: This systematic review and meta-analysis demonstrate that MIS Chevron osteotomy provides clinical and radiological outcomes comparable to those of open Chevron osteotomy. Differences in pain scores, angular correction, and complication rates were small and not clinically meaningful. These findings suggest that MIS Chevron is a safe and effective alternative to open Chevron osteotomy.

Keywords: Chevron osteotomy; Hallux valgus; Minimally invasive surgery; Open surgery; Radiographic outcomes.

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Conflict of interest statement

Declaration of Competing Interest Dr John Kennedy is a consultant for Arthrex and 54 In2Bones. Dr John Kennedy receives financial support from Mr Winston Fisher, Ms Tatiana Rybak and the Ohnell Family Foundation. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. The authors report no other conflict of interests.

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