Work

Minimally invasive versus open talonavicular arthrodesis: comparable functional outcomes in a retrospective comparative cohort

Year: 2026

Type: article

Abstract: BACKGROUND: Talonavicular (TN) arthrodesis is an established procedure for symptomatic TN joint pathology and medial column dysfunction. Open techniques provide direct visualization but may be associated with approach-related soft-tissue morbidity. Minimally invasive surgery (MIS) has been proposed to reduce tissue disruption; however, comparative clinical evidence focusing on functional outcomes remains limited. This study compared functional outcomes between MIS and open TN arthrodesis. METHODS: This retrospective cohort study included 56 feet (55 patients) treated with TN arthrodesis between January 2021 and January 2025. Thirty-two feet underwent MIS TN arthrodesis and 24 feet an open approach. The primary endpoint was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score assessed preoperatively and at final follow-up. Secondary endpoints were operative time and complications. Radiographic follow-up was performed as part of routine care to assess osseous fusion and to guide postoperative rehabilitation. RESULTS: Mean follow-up was 361 ± 69 days. Functional outcomes improved substantially in both groups. Mean AOFAS increased from 53.2 ± 17.6 to 89.4 ± 9.5 in the MIS group (mean gain 36.2 ± 13.3) and from 56.9 ± 14.5 to 87.7 ± 12.7 in the open group (mean gain 30.9 ± 9.1). Between-group differences were not significant for postoperative AOFAS (p = 0.853; Cohen’s d = 0.15) or operative time (59.2 ± 35.6 vs. 69.6 ± 35.1 min; p = 0.415). No complications were documented in the MIS cohort; one patient in the open cohort developed symptomatic nonunion requiring revision (between-group comparison p = 0.389). CONCLUSION: In this retrospective comparative cohort, MIS and open TN arthrodesis were associated with substantial and comparable functional improvement at short-to-midterm follow-up. Complications were uncommon overall; the low event rate precludes firm conclusions regarding comparative safety or nonunion risk. MIS may be considered when soft-tissue preservation is prioritized, and future prospective studies with standardized protocols and PROM-based outcomes are needed. LEVEL OF EVIDENCE: III.

Source: Archives of Orthopaedic and Trauma Surgery

DOI: 10.1007/s00402-026-06282-8

Authors: Felix Werneburg, Dariusch Arbab, Alexander Zeh, Karl-Stefan Delank, Natalia Gutteck

Institutions: Martin Luther University Halle-Wittenberg, Witten/Herdecke University

Language: English

Topic: Foot and Ankle Surgery

Subfield: Orthopedics and Sports Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,590