Cargando…

Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis

BACKGROUND: Adult acquired flatfoot deformity (AAFD) represents a spectrum of deformities affecting the foot and the ankle. The optimal management of AAFD remains controversial. We evaluated the efficacy of surgical treatments of AAFD using both direct and indirect evidences. METHODS: We searched Pu...

Descripción completa

Detalles Bibliográficos
Autores principales: Tao, Xu, Chen, Wan, Tang, Kanglai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385451/
https://www.ncbi.nlm.nih.gov/pubmed/30791933
http://dx.doi.org/10.1186/s13018-019-1094-0
_version_ 1783397207159865344
author Tao, Xu
Chen, Wan
Tang, Kanglai
author_facet Tao, Xu
Chen, Wan
Tang, Kanglai
author_sort Tao, Xu
collection PubMed
description BACKGROUND: Adult acquired flatfoot deformity (AAFD) represents a spectrum of deformities affecting the foot and the ankle. The optimal management of AAFD remains controversial. We evaluated the efficacy of surgical treatments of AAFD using both direct and indirect evidences. METHODS: We searched PubMed, EmBase, and the Cochrane Library to identify eligible studies conducted through November 2018. To compare different surgical strategies, we performed a network meta-analysis. A traditional meta-analysis using a random-effects model was used to evaluate the pooled outcome. RESULTS: A total of 21 studies including 498 patients were collected and analyzed. Network meta-analysis results based on lateral angle talocalcaneal-calcaneal pitch (LAT-CP) indicated that medial displacement calcaneal osteotomy (MDCO) has the highest probability to be the best course of AAFD treatment. However, analyses based on anteroposterior talo-first metatarsal (AP-TMT1) and lateral angle talocalcaneal talo-first metatarsal (LAT-TMT1) suggested that lateral column lengthening (LCL) was the best treatment, while those based on lateral angle talocalcaneal-arch height, anteroposterior talocalcaneal (AP-TC), lateral angle talocalcaneal-talocalcaneal (LAT-TC), anteroposterior-talonavicular coverage (AP-TNC), talonavicular coverage (TNC), and the American Orthopedic Foot and Ankle Society (AOFAS) indicated triple arthrodesis (TAO) as the best treatment. Moreover, double arthrodesis (DAO) provided the best treatment effect on the function score. Furthermore, according to traditional meta-analysis, the summary of standardized mean differences (SMD) indicated that the surgical interventions are associated with significant improvements in LAT-CP (SMD − 1.78), LAT-arch height (SMD − 4.95), AOFAS (SMD − 5.24), AP-TMT1 (SMD 2.45), LAT-TMT1 (SMD 1.97), AP-TC (SMD 3.05), LAT-TC (SMD 2.20), AP-TNC (SMD 2.07), TNC (SMD 1.70), and function score (SMD 0.95). CONCLUSIONS: Our findings indicated that MDCO, LCL, TAO, or DAO might be the best surgical approaches for AAFD treatment. Furthermore, patients who received surgical interventions had significant improvements in symptoms and function. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13018-019-1094-0) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6385451
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-63854512019-03-04 Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis Tao, Xu Chen, Wan Tang, Kanglai J Orthop Surg Res Systematic Review BACKGROUND: Adult acquired flatfoot deformity (AAFD) represents a spectrum of deformities affecting the foot and the ankle. The optimal management of AAFD remains controversial. We evaluated the efficacy of surgical treatments of AAFD using both direct and indirect evidences. METHODS: We searched PubMed, EmBase, and the Cochrane Library to identify eligible studies conducted through November 2018. To compare different surgical strategies, we performed a network meta-analysis. A traditional meta-analysis using a random-effects model was used to evaluate the pooled outcome. RESULTS: A total of 21 studies including 498 patients were collected and analyzed. Network meta-analysis results based on lateral angle talocalcaneal-calcaneal pitch (LAT-CP) indicated that medial displacement calcaneal osteotomy (MDCO) has the highest probability to be the best course of AAFD treatment. However, analyses based on anteroposterior talo-first metatarsal (AP-TMT1) and lateral angle talocalcaneal talo-first metatarsal (LAT-TMT1) suggested that lateral column lengthening (LCL) was the best treatment, while those based on lateral angle talocalcaneal-arch height, anteroposterior talocalcaneal (AP-TC), lateral angle talocalcaneal-talocalcaneal (LAT-TC), anteroposterior-talonavicular coverage (AP-TNC), talonavicular coverage (TNC), and the American Orthopedic Foot and Ankle Society (AOFAS) indicated triple arthrodesis (TAO) as the best treatment. Moreover, double arthrodesis (DAO) provided the best treatment effect on the function score. Furthermore, according to traditional meta-analysis, the summary of standardized mean differences (SMD) indicated that the surgical interventions are associated with significant improvements in LAT-CP (SMD − 1.78), LAT-arch height (SMD − 4.95), AOFAS (SMD − 5.24), AP-TMT1 (SMD 2.45), LAT-TMT1 (SMD 1.97), AP-TC (SMD 3.05), LAT-TC (SMD 2.20), AP-TNC (SMD 2.07), TNC (SMD 1.70), and function score (SMD 0.95). CONCLUSIONS: Our findings indicated that MDCO, LCL, TAO, or DAO might be the best surgical approaches for AAFD treatment. Furthermore, patients who received surgical interventions had significant improvements in symptoms and function. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13018-019-1094-0) contains supplementary material, which is available to authorized users. BioMed Central 2019-02-21 /pmc/articles/PMC6385451/ /pubmed/30791933 http://dx.doi.org/10.1186/s13018-019-1094-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Systematic Review
Tao, Xu
Chen, Wan
Tang, Kanglai
Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title_full Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title_fullStr Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title_full_unstemmed Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title_short Surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
title_sort surgical procedures for treatment of adult acquired flatfoot deformity: a network meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385451/
https://www.ncbi.nlm.nih.gov/pubmed/30791933
http://dx.doi.org/10.1186/s13018-019-1094-0
work_keys_str_mv AT taoxu surgicalproceduresfortreatmentofadultacquiredflatfootdeformityanetworkmetaanalysis
AT chenwan surgicalproceduresfortreatmentofadultacquiredflatfootdeformityanetworkmetaanalysis
AT tangkanglai surgicalproceduresfortreatmentofadultacquiredflatfootdeformityanetworkmetaanalysis