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Sesamoidectomy for the Hallux Sesamoid Disorders

Category: Midfoot/Forefoot Introduction/Purpose: Studies have shown that sesamoidectomy provides good clinical outcomes and quick return to sporting activities, however, there is concern regarding the complications following resection of one or both sesamoid bones. The purpose of the current systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of the hallux sesamoid disorders. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Ten studies with total 196 feet were included. The weighted mean age was 36.6 ± 11.0 with a mean follow-up of 45.1 ± 19.3 months. The mean Visual Analogue Scale score improved from a mean score of 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative AOFAS score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sport, with 90.0% returning to previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1 ± 2.1 preoperatively to 14.8 ± 3.7 postoperatively (p=0.470), and the mean intermetatarsal angle increased from 8.7 ± 0.8 to 9.7 ± 0.8 (p=0.180) following medial sesamoidectomy. The overall complication rate was 22.5%, and further surgeries were required in 3.0%(Table). Conclusion: The current systematic review demonstrated that sesamoidectomy for the hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports activity in the short-term. It is important to note however the high complications rate after sesamoidectomy, with a 22.5% complication rate in the short-term follow-up.