Operative Management for Symptomatic Accessory Navicular: A Systematic Review

Background. The purpose of this systematic review is to evaluate outcomes following surgical intervention for accessory navicular (AN). Methods. The Medline, Embase, and Cochrane Library databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies examining outcomes following surgical management of patients with AN were included. Results. Twenty-three studies comprising 625 patients were operatively treated for AN. The most frequently performed procedure was the Kidner or modified Kidner procedure (n = 403, 51.9%), followed by simple excision (n = 167, 21.5%), arthrodesis (n = 88, 11.3%), arthroeresis (87, 11.2%), and percutaneous drilling (n = 31, 4.0%). The Kidner procedure involves resection of the AN with reattachment of the posterior tibial tendon (PTT) to the navicular, while simple excision involves only resection of the AN. Similar improvements in subjective clinical outcomes were observed across all procedures. The complication rate in the Kidner cohort was 11%, while the arthrodesis cohort demonstrated the highest complication rate (25%) and failure rate (3%). The highest rate of radiographic nonunion was identified in the percutaneous drilling cohort (42%). Age did not appear to influence either clinical outcomes or radiographic outcomes. Conclusions. This systematic review demonstrated satisfactory clinical and radiological outcomes following surgical intervention for symptomatic accessory navicular with moderate complication and failure rates. The most frequently utilized surgical technique was the Kidner procedure and its modifications, which demonstrated excellent clinical and radiological outcomes and is, therefore, the recommended surgical technique for the management of all subtypes of symptomatic AN. Concerning non-union rates were found in the arthrodesis, arthroeresis, and percutaneous drilling cohorts, which may predispose these techniques to failure in the long-term and, thus, are not recommended for the treatment of symptomatic AN. The lack of high-quality studies with a low level of evidence emphasizes the need for better quality comparative studies. Levels of Evidence: IV