Abstract
Category:
Arthroscopy; Midfoot/Forefoot
Introduction/Purpose:
Hallux rigidus is a degenerative disorder of the first metatarsophalangeal (MTP) joint. Patients with this condition experience symptoms including pain, stiffness, and reduced range of motion of the 1st MTP joint. Cheilectomy is a surgical treatment option that removes dorsal periarticular osteophytes to alleviate pain and improve range of motion. Minimally invasive cheilectomy is becoming a more prominent surgical approach due to its clinical benefits including smaller incisions, reduced complications, and faster return to function. This systematic review aims to analyze and present the current literature on patient-reported outcomes (PROs) following MIS cheilectomy for mild to moderate hallux rigidus.
Methods:
A systematic review of the literature was conducted using articles pulled from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases in December 2023 using the search term “cheilectomy.” This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in Prospero (Blinded ID:XX). Articles were included in the systematic review if they reported on preoperative or postoperative patient-reported outcomes in patients undergoing minimally invasive cheilectomy (MIS) in English. Minimally invasive was defined as an arthroscopic or percutaneous approach. The primary outcome measure was scored patient-reported outcomes. The secondary outcome measures included complications, secondary surgeries, surgical techniques, qualitative patient experiences, and grades of hallux rigidus.
Results:
Eight studies met the inclusion criteria, and a total of 284 patients were evaluated. 130/284 underwent an MIS percutaneous approach with burr, 70/284 underwent arthroscopy with shaver, and 84/284 had a combination of both techniques. Most patients (79%) had Coughlin-Shurnas grade one or two hallux rigidus (range: 1-3). The mean American Orthopaedic Foot & Ankle Society scores improved from 57.7 (range: 43-71) to 90.1 (range: 87-97). The mean range of motion (dorsiflexion) improved from 28.5 (range: 8-42) to 49.5 (range: 30-73) degrees. Complication rates were low at 18/284 (6%). The most common complication was numbness, affecting 6/284 (2%) patients. Four out of eight articles reported zero complications. 113/125 (90.4%) patients would recommend the procedure.
Conclusion:
Treatment of hallux rigidus with MIS cheilectomy appears to result in favorable and safe outcomes when performed for patients with early degenerative disease who have failed conservative treatment. Patients reported high satisfaction rates, significant symptomatic improvements, and experienced low complication rates.