Does endoscopic repair reduce complications in proximal hamstring avulsions? A systematic review of current concepts

Proximal hamstring tendon avulsions represent significant musculoskeletal injuries, particularly among athletes, and often necessitate surgical intervention. While open repair has long been considered the standard approach, endoscopic techniques have recently emerged as a less invasive alternative, potentially reducing soft tissue trauma and recovery time. However, comparative evidence between these techniques remains limited. This study systematically compares the clinical and radiological outcomes, complication rates, and return-to-sport rates following open versus endoscopic repair of proximal hamstring tendon avulsions.

This systematic review was carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. A comprehensive search was conducted across five electronic databases: PubMed, Embase, Scopus, Cochrane Library, and MEDLINE, to retrieve retrospective studies (Levels of Evidence 1-4) that compared open and endoscopic techniques for proximal hamstring tendon avulsion repair, with a follow-up period of at least 12 months. Primary outcomes assessed included patient-reported outcome measures (PROMs), return-to-sport rates, patient satisfaction levels, postoperative complication rates, and reoperation frequencies.

Five retrospective studies, involving 181 patients (84 undergoing open repair and 97 undergoing endoscopic repair), were analyzed. Both techniques resulted in significant improvements in PROMs (mHHS, iHOT-12, HOS-SS, PROMIS-PF), with endoscopic repair demonstrating superior rates of clinically meaningful improvement in selected cases. Return-to-activity rates ranged from 62 % to 100 %, with high patient satisfaction across both groups (90-100 %). Complication rates were significantly lower in the endoscopic group (10.3-15.8 %) compared to open repair (34 %), with fewer reoperations reported.

Endoscopic repair of proximal hamstring avulsions appears to be associated with lower complication and reoperation rates compared to open techniques, while providing similar functional outcomes. However, these findings should be interpreted with caution, given the small number of retrospective studies, potential selection bias in treatment allocation, and the absence of randomized comparative trials. Further high-quality prospective research is needed to validate these preliminary observations.

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