Role of Lateral Soft Tissue Release in Percutaneous Hallux Valgus Surgery: A Systematic Review of the Literature

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The utility of Lateral soft tissue release (LSTR) in the setting of percutaneous Hallux Valgus (PHV) surgery is still debated. Our aim was to conduct a systematic review of the literature comparing the results of PHV surgery with and without LSTR in order to define the benefits and risks related to this procedure. Our hypotheses were that LSTR would 1) reduce the risk or recurrence of the deformity without increasing the risk of complication and 2) lead to an improved clinical outcome with greater radiological correction. Methods: This systematic review followed the PRISMA checklist and was prospectively registered in the Prospero database (CRD4202230). Pubmed, Embase, Cochrane Library and Scopus were used to identify clinical papers reporting results after PHV surgery. Studies were pooled in two categories: PHV with LSTR (Group 1 or G1) and PHV without LSTR (Group 2 or G2). Data regarding the study design, demographics, the surgical procedure and the clinical and radiological outcome were extracted and compared. The modified Coleman Methodology score (mCMS) was used to assess the quality of studies included. Results: Sixteen studies were selected (G1:594 feet;G2:553 feet). The sample size (p=0.11), sex distribution (p=0.57), length of follow-up (p=0.79), size of the incision (p=0.13) were comparable. Studies in G2 included a younger population (54+-6.3 vs 44.4+- 6.8 years;p=0.006), however age did not correlate with the clinical and radiological outcome (all p>0.05). The pooled proportion of complication in the two groups (27%, 95%CI 17-38 and 25%, 95%CI 12-37, respectively) and the pooled proportion of recurrence at a minimum 18-month follow-up (2%, 95%CI 0-3 and 2%, 95%CI 0-5, respectively) didn't differ (p=0.79 and p=0.70). The pre- (51.7+-10.6 and 45.8+-1.7 points;p=0.23) and post-operative AOFAS scores (89.4+-4.3 and 86.9+-3.2 points;p=0.16) and the pre-(HVA:29.7+-2.9 and 44.1+-26.8 degrees,p=0.23)(IMA:12.5+-4.2 and 14.1+-2.6 degrees;p=0.94) and post-operative radiological angles (HVA:12.1+-4.3 and 12.3+-2.3;p=0.47)(IMA:9.2+-2.2 and 7.9+-1.3;p=0.2) didn't differ in the two groups. The methodological quality of studies (mCMS: 68.7+-11 points in G1, 63.4+-14.3 points in G2;p=0.2) was similar in G1 and G2 Conclusion: Lateral soft tissue release during percutaneous HV surgery does not seem to improve the clinical and radiological outcome nor reduces the risk of recurrence of the deformity at a mean 4-year follow-up.