Lateral Column Lengthening For Flexible Adult Acquired Flatfoot: Systematic Review and Meta-Analysis

Flexible Adult Acquired Flatfoot is known to have multiplanar components and can often be a challenge to manage in the clinical setting, with resistance to non-surgical intervention. Lateral Column Lengthening is a favorable option for surgical management, although there are several methods in achieving this, an opening wedge osteotomy of the anterior calcaneus or distraction arthrodesis of the calcaneocuboid joint appear to be the 2 most widespread. In this review we conducted in systematic fashion, analysis of the available literature utilizing the following electronic bibliographic databases, in line with the PRISMA-P checklist: MEDLINE, CINHAL, EMBASE, and the Cochrane library without date restriction up to November 1, 2019. Results identified 21 studies which were assessed for quality using the Coleman methodology score and later evaluated using the PICO analysis system. From 172 participants, we found a higher rate of graft failure with the use of allograft versus autograft, although from a total 355 cases union rates were reported as similar. From the 355, fewer complications with arthrodesis in comparison to osteotomy were reported, including that of post-operative lateral column pain. Surgical intervention using either lateral column procedure yields excellent clinical and radiological results, the literature findings marginally favor the arthrodesis procedure and autograft over allograft. Keeping graft size under 8 mm was found to be clinically important to mitigate overlengthening of the lateral column and biomechanical testing exhibited triangular graft superiority. Where significant correction is required the addition of a medial column stabilization procedure will mitigate post-operative intractable lateral column pain.