Does Less Invasive Mean Better? Patient-Reported Outcomes Following Minimally Invasive Versus Open Hallux Valgus Surgery: A Systematic Review and Meta-Analysis

Introduction Hallux valgus is a common forefoot deformity, and minimally invasive surgery has emerged as an alternative to open correction. This review aimed to compare patient-reported outcomes between the two approaches. Materials and Methods This PRISMA 2020-guided systematic review and meta-analysis searched PubMed, Science Direct, Google Scholar, and Cochrane CENTRAL. Studies comparing minimally invasive surgery (MIS) with open hallux valgus surgery, reporting American Orthopaedic Foot and Ankle Society (AOFAS), Visual Analogue Scale (VAS), radiographic, or complication data, were included. Random-effects meta-analysis with the Hartung-Knapp adjustment was used, with sensitivity and funnel plot analyses. Risk of bias was assessed using Cochrane RoB 2 for randomised trials, ROBINS-I for non-randomised studies and JBI checklist for case series. Results Eighteen studies were included. For functional patient-reported outcome measures (PROMs) (AOFAS or patient-reported outcomes measurement information system (PROMIS) Physical Function), 7 studies (459 participants) showed standardized mean difference (SMD) 0.53 (95% CI −0.19 to 1.26; p=0.123; I²=89.1%). For VAS pain, 3 studies (194 participants) showed mean difference (MD) −0.09 (95% CI −0.67 to 0.49; p=0.571; I²=0%). For hallux valgus angle (HVA), 9 studies (657 participants) showed MD 0.52° (95% CI −1.78 to 2.82; p=0.618; I²=74.7%). For intermetatarsal angle (IMA), 9 studies (664 participants) showed 0.18° (95% CI −2.14 to 2.50; p=0.864; I²=97.2%). For complications, odds ratio (OR) was 0.68 (95% CI 0.27–1.71; p=0.366; I²=58.4%). Conclusion No significant difference exists between MIS and open surgery on patient-reported pain, function, radiographic correction, or complications for hallux valgus. Further high-quality trials are required.