Advancements in Artificial Intelligence for Foot and Ankle Surgery: A Systematic Review

Abstract

Background: There has been a rapid increase in research applying artificial intelligence (AI) to various subspecialties of orthopaedic surgery, including foot and ankle surgery. The purpose of this systematic review is to (1) characterize the topics and objectives of studies using AI in foot and ankle surgery, (2) evaluate the performance of their models, and (3) evaluate their validity (internal or external validation). Methods: A systematic literature review was conducted using PubMed/MEDLINE and Embase databases in December 2022. All studies that used AI or its subsets machine learning (ML) and deep learning (DL) in the setting of foot and ankle surgery relevant to orthopaedic surgeons were included. Studies were evaluated for their demographics, subject area, outcomes of interest, model(s) tested, model(s)’ performance, and validity (internal or external). Results: A total of 31 studies met inclusion criteria: 14 studies investigated AI for image interpretation, 13 studies investigated AI for clinical predictions, and 4 studies were grouped as “other.” Studies commonly explored AI for ankle fractures, calcaneus fractures, hallux valgus, Achilles tendon pathologies, plantar fasciitis, and sports injuries. For studies reporting the area under the receiver operating characteristic curve (AUC), AUCs ranged from 0.64 (poor) to 0.99 (excellent). Two studies (6.45%) reported external validation. Conclusion: Applications of AI in the field of foot and ankle surgery are expanding, particularly for image interpretation and clinical predictions. Current model performances range from poor to excellent, and most studies lack external validation, demonstrating a need for further research prior to deploying AI-based clinical applications. Level of Evidence: Level III, retrospective cohort study.

Evaluating the Quality and Usability of Artificial Intelligence–Generated Responses to Common Patient Questions in Foot and Ankle Surgery

“…Merrill et al 14 internally validated these approaches and found both models to perform similarly, with areas under the curves for logistic regression ranging from 0.7101 to 0.7583 and areas under the curves for gradient boosting ranging from 0.6979 to 0.7580. A recent systematic review by Gupta et al 7 provides an overview of 31 studies related to the use of AI in foot and ankle surgery and is an excellent resource for surgeons interested in learning about the capabilities of AI in our feild.…”

“…The use of artificial intelligence (AI) methodologies for various applications in orthopaedic foot and ankle surgery is growing. 3,[7][8][9][10]24 ChatGPT (Generative Pretrained Transformer) (Open AI, San Francisco, CA) was launched by OpenAI on November 30, 2022, and is a generative language model tool with the capacity to enable the public to converse with an AI network utilizing a text-based platform. Early in 2023, ChatGPT was the fastest-growing consumer application to date, reaching more than 100 million users.…”

Biomechanical comparison of two surgical methods for Hallux Valgus deformity: Exploring the use of artificial neural networks as a decision-making tool for orthopedists

“…This review highlights the remarkable achievements of artificial intelligence models in various tasks, such as fracture recognition, evaluating surgical suitability, and predicting surgical outcomes. A recent survey [26] underscores that the majority of current studies in this domain revolve around AI applications for imaging analysis, with a particular focus on fracture identification and classification. For a more comprehensive exploration of AI applications in foot and ankle surgery, interested readers are encouraged to consult [24][25][26] and the references cited therein.…”

“…A recent survey [26] underscores that the majority of current studies in this domain revolve around AI applications for imaging analysis, with a particular focus on fracture identification and classification. For a more comprehensive exploration of AI applications in foot and ankle surgery, interested readers are encouraged to consult [24][25][26] and the references cited therein.…”