MINIMALLY INVASIVE SERI TECHNIQUE FOR THE TREATMENT OF JUVENILE HALLUX VALGUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Juvenile hallux valgus (JHV) is characterized by varus deviation of the first metatarsal and valgus deviation of the proximal phalanx, commonly observed in paediatric populations. JHV presents unique challenges, with symptoms ranging from cosmetic issues to functional limitations. Management remains a topic of debate, with multiple treatment options available, including splinting, footwear adjustments, activity limitations, and surgical interventions. The Simple, Effective, Rapid, and Inexpensive (SERI) technique, a minimally invasive distal first metatarsal osteotomy, has gained attention for its potential to offer effective correction with minimal complications and short operative time. However, its application in younger patients remains underexplored due to concerns of skeletal maturity, operative complications, and recurrence risk. This systematic review evaluates the clinical and radiographic outcomes of the SERI technique in JHV treatment. Medline, Embase, CENTRAL, CINAHL Complete, and SPORTDiscus databases were searched from inception to April 05, 2024 for studies reporting on the outcomes of the minimally invasive SERI technique for JHV treatment. Following the PRISMA/R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews of Interventions, studies were screened for relevance, and data were extracted on demographic information, radiographic measurements, patient-reported outcomes, and complications. We employed random effects models to conduct meta-analyses and the generic inverse variance method to estimate study weights. Five studies, encompassing 153 patients (208 feet) treated with the SERI technique, met inclusion criteria. Four were retrospective cohort studies; the remaining was a case series. The mean patient age was 14.56 years, with 80.39% (n=123) female. The mean follow-up duration was 43 months (range: 19.9–72 months). The mean surgical durations recorded in two studies were 5.2 and 23.0 minutes. Postoperatively, the mean hallux valgus angle (HVA) improved from 26.1° to 10.54°, the mean intermetatarsal angle (IMA) decreased from 14.2° to 6.82°, and the mean distal metatarsal articular angle (DMAA) improved from 12.43° to 4.93°. The pooled data showed that postoperatively, the mean HVA improved by −15.19° (95% CI: −16.72°, −13.65°), the mean IMA improved by −7.18° (95% CI: −8.48°, −5.88°), and the mean DMAA improved by −7.79° (95% CI: −15.10°, −0.48°). The SERI technique also resulted in a mean American Orthopaedic Foot & Ankle Society (AOFAS) score improvement of 33.45 (95% CI: 18.93, 47.96; MCID: 7.9 - 30.2), with scores improving across all studies. There were 11 (5.29%) minor complications documented, including subcutaneous K-wire insertion, inflammatory reactions, range of motion limitation, and delayed wound healing. No significant long-term repercussions were observed. Our review indicates that the SERI technique is an effective and safe surgical option for treating JHV, resulting in significant improvements in radiographic measurements and patient-reported outcomes. The SERI procedure's minimally invasive nature and short operative times are additional benefits. However, the limited number of studies in paediatric populations highlights the need for more trials with larger sample sizes and longer follow-up periods to better evaluate the procedure's long-term efficacy.