Abstract：
Open in situ subtalar arthrodesis (ISTA) has been a standard procedure for treating subtalar arthritis for varied etiologies with good outcomes. There has been a paradigm shift from ISTA to arthroscopic subtalar arthrodesis (ASTA) over the past two decades due to increase in number of surgeons performing arthroscopy worldwide. However, there is only limited evidence in the existing literature to substantiate the benefit of this change with regards to patient benefit. To our knowledge, there are also no systematic reviews comparing the results of the two techniques for subtalar arthrodesis (STA).
Our systematic review aims to determine the superior technique for performing STA by comparing the outcomes, union rates, and complications between open and arthroscopic approach for in situ STA. We hypothesised that both procedures would have similar outcomes, union rates, time to union, and complication rate for in-situ STA.
Three databases, MEDLINE/PubMed, the Cochrane Library, and Google Scholar, were searched using predefined inclusion and exclusion criteria to compare the two procedures. Risk of bias assessment was done using The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool for assessing the risk of bias in the included studies. Weighted mean averages were computed for all parameters and tabulated separately for ASTA and ISTA.
We included a total of 22 studies with a total of 978 (ASTA-310, ISTA-668) patients in the review. The most common indication for both techniques was post traumatic subtalar arthritis due to malunited calcaneal fracture in both groups (54.5%). The American Orthopaedic Foot & Ankle Society score was better in the ASTA group with a weighted average improvement of 43.4, while the weighted average improvement was 31.1 in the ISTA group, respectively. Patients undergoing ASTA had a weighted average union rate of 95.5% (standard deviation [SD]-3.6) with a weighted average time to union of 12.2 weeks (SD-2.4) while the ISTA group reported 90.7% (SD-6) union rate with a weighted average time to union of 15.5 weeks (SD-8.4). The weighted overall average complication rate was 13.1% (SD-8.9) in ASTA group and 20.3% (SD-16.2) in the ISTA group with hardware-related complications being the most common in both the groups.
From the existing literature, our review suggests that both ASTA and ISTA techniques are effective procedures for STA. However, there is no conclusive evidence to recommend one technique over another. High quality randomised studies may be further required to clearly define the superiority of one technique over another LEVEL OF EVIDENCE: level III.
Our systematic review aims to determine the superior technique for performing STA by comparing the outcomes, union rates, and complications between open and arthroscopic approach for in situ STA. We hypothesised that both procedures would have similar outcomes, union rates, time to union, and complication rate for in-situ STA.
Three databases, MEDLINE/PubMed, the Cochrane Library, and Google Scholar, were searched using predefined inclusion and exclusion criteria to compare the two procedures. Risk of bias assessment was done using The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool for assessing the risk of bias in the included studies. Weighted mean averages were computed for all parameters and tabulated separately for ASTA and ISTA.
We included a total of 22 studies with a total of 978 (ASTA-310, ISTA-668) patients in the review. The most common indication for both techniques was post traumatic subtalar arthritis due to malunited calcaneal fracture in both groups (54.5%). The American Orthopaedic Foot & Ankle Society score was better in the ASTA group with a weighted average improvement of 43.4, while the weighted average improvement was 31.1 in the ISTA group, respectively. Patients undergoing ASTA had a weighted average union rate of 95.5% (standard deviation [SD]-3.6) with a weighted average time to union of 12.2 weeks (SD-2.4) while the ISTA group reported 90.7% (SD-6) union rate with a weighted average time to union of 15.5 weeks (SD-8.4). The weighted overall average complication rate was 13.1% (SD-8.9) in ASTA group and 20.3% (SD-16.2) in the ISTA group with hardware-related complications being the most common in both the groups.
From the existing literature, our review suggests that both ASTA and ISTA techniques are effective procedures for STA. However, there is no conclusive evidence to recommend one technique over another. High quality randomised studies may be further required to clearly define the superiority of one technique over another LEVEL OF EVIDENCE: level III.
摘要：
目的：开放原位距下关节固定术（ISTA）已成为治疗多种病因的距下关节炎的标准方法，具有良好的疗效。在过去的二十年中，由于全球范围内进行关节镜检查的外科医生数量的增加，从ISTA到关节镜距下关节固定术（ASTA）的范式转变。然而,现有文献中只有有限的证据来证实这种改变对患者获益的益处.据我们所知,也没有系统评价比较两种距下关节固定术(STA)技术的结果.
目的：我们的系统评价旨在通过比较结果来确定进行STA的优越技术，工会费率，开放和关节镜入路原位STA的并发症。我们假设这两个程序会有相似的结果，工会费率，工会的时间，原位STA的并发症发生率。
方法：三个数据库，MEDLINE/PubMed,Cochrane图书馆,和谷歌学者，使用预定义的纳入和排除标准进行搜索，以比较两个程序。使用非随机干预研究中的偏倚风险（ROBINS-I）工具进行偏倚风险评估，以评估纳入研究中的偏倚风险。计算所有参数的加权平均值，并分别为ASTA和ISTA制表。
结果：我们共纳入了22项研究，共978例患者（ASTA-310，ISTA-668）。两种技术最常见的适应症是两组中由于跟骨骨折畸形引起的创伤性距下关节炎（54.5％）。ASTA组的美国骨科足踝协会评分较好，加权平均改善为43.4，而ISTA组的加权平均改善为31.1，分别。接受ASTA的患者的加权平均愈合率为95.5％（标准偏差[SD]-3.6），加权平均愈合时间为12.2周（SD-2.4），而ISTA组报告90.7％（SD-6）愈合率，加权平均愈合时间为15.5周（SD-8.4）。ASTA组的加权总体平均并发症发生率为13.1%（SD-8.9），ISTA组为20.3%（SD-16.2），硬件相关并发症在两组中最常见。
结论：从现有文献来看，我们的审查表明，ASTA和ISTA技术都是STA的有效程序。然而,没有确凿的证据可以推荐一种技术。可能还需要进行高质量的随机研究，以明确定义一种技术优于另一个证据级别：III级。
目的：我们的系统评价旨在通过比较结果来确定进行STA的优越技术，工会费率，开放和关节镜入路原位STA的并发症。我们假设这两个程序会有相似的结果，工会费率，工会的时间，原位STA的并发症发生率。
方法：三个数据库，MEDLINE/PubMed,Cochrane图书馆,和谷歌学者，使用预定义的纳入和排除标准进行搜索，以比较两个程序。使用非随机干预研究中的偏倚风险（ROBINS-I）工具进行偏倚风险评估，以评估纳入研究中的偏倚风险。计算所有参数的加权平均值，并分别为ASTA和ISTA制表。
结果：我们共纳入了22项研究，共978例患者（ASTA-310，ISTA-668）。两种技术最常见的适应症是两组中由于跟骨骨折畸形引起的创伤性距下关节炎（54.5％）。ASTA组的美国骨科足踝协会评分较好，加权平均改善为43.4，而ISTA组的加权平均改善为31.1，分别。接受ASTA的患者的加权平均愈合率为95.5％（标准偏差[SD]-3.6），加权平均愈合时间为12.2周（SD-2.4），而ISTA组报告90.7％（SD-6）愈合率，加权平均愈合时间为15.5周（SD-8.4）。ASTA组的加权总体平均并发症发生率为13.1%（SD-8.9），ISTA组为20.3%（SD-16.2），硬件相关并发症在两组中最常见。
结论：从现有文献来看，我们的审查表明，ASTA和ISTA技术都是STA的有效程序。然而,没有确凿的证据可以推荐一种技术。可能还需要进行高质量的随机研究，以明确定义一种技术优于另一个证据级别：III级。
