Modern Treatment of Hallux Rigidus by Cheilectomy: A Systematic Review of Patient-Reported Outcomes in Minimally Invasive Techniques

Abstract

Background: Minimally invasive cheilectomy is becoming a more prominent surgical approach in the management of mild to moderate hallux rigidus. This systematic review aims to analyze and present the current literature on patient-reported outcomes following minimally invasive (MIS) cheilectomy for mild to moderate hallux rigidus. Methods: PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched in April 2024. Inclusion criteria consisted of articles evaluating patients undergoing cheilectomy through an MIS approach either using fluoroscopy or arthroscopy, studies that reported patient-reported outcomes, and studies written in English. The primary outcome measure was scored patient-reported outcomes. The secondary outcome measures included complications, secondary surgeries, surgical techniques, return to activity, patient satisfaction, and grades of hallux rigidus. Results: Eight studies met the inclusion criteria, and a total of 296 patients were evaluated. Overall, 36 of 296 (12.2%) underwent arthroscopy with a shaver, 130 of 296 (43.9%) underwent an MIS percutaneous approach with burr, and 130 of 296 (43.9%) had a combination of both techniques. The mean reported range of motion (dorsiflexion) improved from 32.4 degrees (range, 6.3-50.0 degrees) to 61.2 degrees (range, 47.6-89.6 degrees). All studies that reported patient outcomes scores demonstrated improved outcomes regardless of surgical technique. Overall combined reported complication rate was 18 of 296 (6.1%), with the most common complication being dorsomedial cutaneous nerve problems, affecting 6 of 296 patients (2.0%). Conclusion: Minimally invasive cheilectomy results in positive patient outcomes, patient satisfaction, preserves range of motion, and has low complication rates for the treatment of mild to moderate hallux rigidus.