Mid- and long-term outcomes of endoscopic versus open gluteal tendon repair: a systematic review and multilevel meta-analysis

Purpose: Evidence on short-term outcomes of open versus endoscopic gluteal tendon repair is available, but the durability of these results beyond the early postoperative phase remains unclear. To date, no data synthesis has specifically addressed mid- to long-term outcomes. The aim of this study was, therefore, to conduct a systematic review and multilevel meta-analysis to compare mid- and long-term functional and pain outcomes following open versus endoscopic gluteal tendon repair. Methods: PubMed, Embase, CENTRAL, and Epistemonikos were searched through 30 September 2025. Outcomes of open versus endoscopic gluteal tendon repair were synthesized using a multilevel random-effects meta-analysis with restricted maximum likelihood and Hartung–Knapp adjustments. Continuous data were reported as mean differences with 95% confidence intervals, and heterogeneity was assessed with Higgins’ I 2 . Results: Nine studies comprising 264 patients (269 hips) were included. Endoscopic repair demonstrated significantly superior mid- to long-term functional improvement compared with open repair ( F = 7.91, P = 0.01) and greater functional gain over time ( F = 8.79, P = 0.01). Postoperative pain outcomes were comparable between groups ( F = 0.98, P = 0.34), yet endoscopic repair achieved a significantly greater reduction in pain at follow-up ( F = 9.79, P < 0.01). Conclusion: Endoscopic gluteal tendon repair is associated with superior long-term functional outcomes and lower complication rates compared to open repair, supporting its role as the preferred surgical approach for most patients. Level of evidence: IV (systematic review and meta-analysis of Level IV studies).