Endoscopic gluteal tendon repair reduces complication rates while achieving outcomes comparable to open repair: A multilevel meta‐analysis

Abstract Purpose The purpose of this systematic review and multilevel meta‐analysis was to compare short‐term functional outcomes, pain relief, and complication rates between open and endoscopic gluteal tendon repair, expressed as functional improvement normalized to minimal clinically important difference (MCID) units. The hypothesis was that endoscopic repair would provide comparable clinical efficacy with a lower complication rate compared with open repair. Methods PubMed, Embase, CENTRAL and Epistemonikos were searched to 15 October 2025. Eligible primary studies reporting postoperative or change outcomes were synthesized with a frequentist multilevel random‐effects model (inverse variance, restricted maximum likelihood estimation, Hartung–Knapp adjustment). Results Thirty‐four studies (1278 patients; 1283 hips) met criteria. Postoperative functional MCID (27 studies; n = 1005): overall 9.01 (95% confidence interval [CI]: 8.11–9.91; I 2 = 100%; τ 2 = 5.2); open 9.09 (8.12–10.06; six studies; n = 398) versus endoscopic 8.96 (8.02–9.90; 17 studies; n = 607); no subgroup difference ( p = 0.63). Change in functional MCID (21 studies; n = 718): overall 3.33 (2.86–3.81; I 2 = 83%; τ 2 = 0.9); open 3.10 (2.39–3.81; nine studies; n = 290) versus endoscopic 3.52 (2.89–4.15; 12 studies; n = 428); no difference ( p = 0.36). Postoperative pain MCID (19 studies; n = 867): overall 1.71 (1.27–2.16; I 2 = 98%; τ 2 = 0.9); open 1.58 (1.03–2.13; nine studies; n = 349) versus endoscopic 1.81 (1.31–2.32; 11 studies; n = 518); no difference ( p = 0.38). Change in pain MCID (19 studies; n = 798): overall –1.99 (–2.74 to –1.24; I 2 = 99%; τ 2 = 2.5); open –1.82 (–2.96 to –0.69; nine studies; n = 349) versus endoscopic –2.12 (–3.18 to –1.09; 11 studies; n = 449); no difference ( p = 0.68). Overall complications (25 studies; n = 804): 58/804 (0.07; 95% CI: 0.05–0.11; I 2 = 53%; τ 2 = 0.8); open 33/371 (0.08; 0.04–0.16) versus endoscopic 25/433 (0.07; 0.04–0.12); no difference ( p = 0.70). Conclusion Open and endoscopic gluteal tendon repair provide clinically meaningful short‐term improvements in function and pain, with no relevant differences in efficacy when interpreted using MCID units. These findings support both techniques in clinical practice and favour endoscopic repair when available due to its less invasive nature. Level of Evidence Level III, systematic review and meta‐analysis of predominantly Level III studies.