Baseline data

The main characteristics of the 10 included studies are shown in Table 1 [5,6,7,8,9,10,11,12,13,14].The sample sizes ranged from 60 to 136 patients, with a total of 985 patients. The average age of the patients varied from 32.7 to 54 years. Stratification by gender was reported in eight studies, with a percentage of males ranging from 0 to 13.7%. The patients had a follow-up between 12 and 56.4 months.

Table 1 Characteristics of randomized clinical trials included in the meta-analysis

Radiological outcomes

The hallux valgus angle (HVA) was described in 11 studies. Four were excluded—one for not providing the standard deviation and three for being isolated non-comparable studies. Seven studies were included: three related to the scarf technique, with 341 patients; two studies compared distal Chevron osteotomy with the Lindgren technique, with 156 patients; and two studies comparing proximal and distal chevron osteotomies, with 202 patients.

The results regarding the change between HVA showed a greater reduction in the distal chevron osteotomy when compared with the scarf technique (MD − 2.18, 95% CI − 3.67, − 0.69, p = 0.004, I2 = 0%) (Fig. 3a). There were no significant differences in HVA when the Lindgren and distal chevron techniques were compared (MD 0.82, 95% CI − 3.62, 5.26, p = 0.72, I2 = 79%) (Fig. 3b). No significant differences were observed between the proximal and distal chevron osteotomies (MD 1.26, 95% CI − 0.67, 3.19, p = 0.2, I2 = 0%) (Fig. 3c). The funnel plot diagrams did not show the existence of publication bias (Fig. 4).

Fig. 3
figure 3

Forest plot of Hallux Valgus Angle: a HVA correction between distal chevron and scarf; b HVA correction between distal chevron and Lindgren; c HVA correction between distal chevron and proximal chevron

Fig. 4
figure 4

Hallux Valgus Angle funnel plot diagrams: a Distal chevron versus scarf; b Distal chevron versus Lindgren; c Distal chevron versus proximal chevron

The intermetatarsal angle (IMA) was described in 10 studies, of which three were excluded because they were isolated, non-comparable studies. Seven studies were included: three, with a total of 341 patients, dealt with the scarf technique; two studies, with a total of 156 patients, compared distal Chevron osteotomy with the Lindgren technique; and two studies compared the proximal and distal chevron osteotomies.

The results regarding pre- and postoperative IMA values did not show significant differences between the distal chevron and scarf osteotomies (MD − 0.77, 95% CI 1.89, 0.35, p = 0.18, I2 = 75%) (Fig. 5a). No significant differences were observed between the Lindgren and distal chevron techniques (MD 1.14, 95% CI − 0.63, 2.91, p = 0.21, I2 = 81%) (Fig. 5b). Finally, a greater reduction in the IMA was observed in proximal chevron than in distal chevron osteotomies (MD − 1.08, 95% CI 0.29, 1.86, p = 0.007, I2 = 0%) (Fig. 5c). The funnel plot diagrams did not show the existence of publication bias (Fig. 6).

Fig. 5
figure 5

Forest plot of Inter Metatarsal Angle: a IMA correction between distal chevron and scarf; b IMA correction between distal chevron and Lindgren; c IMA correction between distal chevron and proximal chevron

Fig. 6
figure 6

Inter Metatarsal Angle funnel plot diagrams: a Distal chevron versus scarf; b Distal chevron versus Lindgren; c Distal chevron versus proximal chevron

Clinical outcomes

The AOFAS scale was described in seven studies. Three studies were excluded, one due to lack of information on the standard deviation and two because they were isolated non-comparable studies. Four studies were included. Two studies, with a total of 156 patients, compared distal chevron osteotomy with the Lindgren technique, and two studies, with a total of 202 patients, compared distal chevron with proximal chevron osteotomy.

The AOFAS before and after surgery showed a significantly improvement in the Lindgren technique compared with distal chevron (MD 3.20, 95% CI: 0.37, 6.04, p = 0.03, I2 = 0%) (Fig. 7a). No significant differences were observed between the proximal and distal chevron (MD 0.96, 95% CI − 1.85, 3.77, p = 0.5, I2 = 0%) (Fig. 7b). The funnel plot diagrams did not show the existence of publication bias (Fig. 8).

Fig. 7
figure 7

Forest plot of AOFAS scale: a AOFAS correction between distal chevron and Lindgren; b AOFAS correction between distal chevron and proximal chevron

Fig. 8
figure 8

AOFAS funnel plot diagrams: a Distal chevron versus Lindgren; b Distal chevron versus proximal chevron

Source

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