Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2021; 12(6): 433-444
Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.433
Arthroereisis in juvenile flexible flatfoot: Which device should we implant? A systematic review of literature published in the last 5 years
Andrea Vescio, Gianluca Testa, Mirko Amico, Claudio Lizzio, Marco Sapienza, Piero Pavone, Vito Pavone
Andrea Vescio, Gianluca Testa, Mirko Amico, Claudio Lizzio, Marco Sapienza, Vito Pavone, Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Catania 95123, Italy
Piero Pavone, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania 95123, Italy
Author contributions: All the authors contributed equally to this work.
Conflict-of-interest statement: The authors have no competing interests to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vito Pavone, MD, PhD, Associate Professor, Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy. vitopavone@hotmail.com
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: February 15, 2021
Revised: March 21, 2021
Accepted: May 8, 2021
Article in press: May 8, 2021
Published online: June 18, 2021
Processing time: 191 Days and 18.8 Hours
Abstract
BACKGROUND

Flexible flatfoot (FFF) is a very common condition in children, characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot. Arthroereisis (AR) procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop (CS).

AIM

We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients. We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population, young athletes, and obese people according to material device.

METHODS

Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6, 2020. The research string used was (pediatric OR children OR Juvenile NOT adult) AND (flexible NOT rigid) AND (flat foot OR pes planus) AND (calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal). The risk of bias assessment was performed using the Dutch checklist form for prognosis.

RESULTS

A total of 47 articles were found. Ultimately, after reading the full text and checking reference lists, we selected 17 articles that met the inclusion and exclusion criteria. A total of 1864 FFFs were identified. Eight studies concerned the subtalar AR (47.1%) and nine concerning CS (52.9%). The average age of patients at start of treatment was 11.8 years, the average follow-up of the studies was 71.9 mo (range 29.1-130). Globally, complications occurred in 153 of the 1864 FFF treated, with a rate of 8.2%.

CONCLUSION

Both AR procedures are valid surgical techniques for treating FFF. Surgeon experience, implant cost, and cosmetic correction are the most common considerations included in the orthopedic device decision-making process. In obese patients, the subtalar AR is not recommended. In adolescents who need to improve sports performance, the CS screw had better results compared with other implants.

Keywords: Pes planus; Arthroereisis; Treatment; Calcaneo-stop; Subtalar arthroereisis; Complication

Core Tip: Arthroereisis (AR) procedures are widely performed corrective surgeries for juvenile flexible flatfoot. The AR procedures include impact blocking devices and self-locking implants. Impact blocking devices include subtalar extra-articular calcaneo-stop (CS) screws that have a stem and a head and interfere with the talus. Self-locking implants (subtalar AR) are inserted in the sinus tarsi along its main axis. Surgeon experience, implant cost, and, cosmetic correction are the most common criteria included in the orthopedic decision-making process. Both AR procedures improved clinical and radiological parameters. Considering the complications, calcaneo-stop screws had a slightly better rate than subtalar AR.