Comparison of distal minimally invasive metatarsal osteotomy and open chevron osteotomy in the treatment of hallux valgus (HV): A network meta-analysis.

Abstract

Hallux valgus (HV) is a prevalent foot deformity with complex pathogenesis. This study aims to compare distal minimally invasive osteotomy and open chevron osteotomy for HV treatment. A Network Meta-Analysis METHODS: The meta-analysis consisted of 14 studies (842 patients) from PubMed, Web of Science, Embase, and Cochrane Library (until April 2026). The retrieval strategies comprised the terms 'hallux valgus', 'percutaneous', 'minimally invasive surgery', 'mica' and 'chevron'. Outcomes included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and AOFAS scores, which were calculated leveraging a 95 % credible interval (CI). Study quality was evaluated adopting NIH tools, and statistical analysis was carried out utilizing R (version 4.4.1). A total of 14 articles involving 842 participants were included in this study. The results indicated that, compared with open chevron osteotomy, minimally invasive transverse osteotomy showed a more effective therapeutic effect in improving the HVA ([SD: -1.5, 95 % CI (-2.5, -0.39)] (SUCRA = 98.17 %) and IMA ([SD: -0.76, 95 % CI (-1.3, -0.20)] (SUCRA=98.82 %). In terms of improving the DMAA, minimally invasive chevron osteotomy (SD: -5.8, 95 % CI: -8 to -3.7; SUCRA = 98.80 %) and minimally invasive transverse osteotomy (SD: -2.6, 95 % CI: -3.9 to -1.4; SUCRA = 54.18 %) were both more effective. Minimally invasive chevron osteotomy ranked highest in terms of AOFAS score (SUCRA=81.53 %). However, This estimate was associated with a wide CI [SMD:2.4, 95 %CI(0.48,4.3)]. Minimally invasive transverse osteotomy is more effective for radiographic correction (HVA/IMA), whereas minimally invasive chevron osteotomy appears to improve functional outcomes. These findings suggest potential differences between the techniques but should be interpreted in light of indirect comparisons and study heterogeneity.