EP7.15 Clinical Outcomes After Proximal Hamstring Repair With Concomitant Sciatic Nerve Neurolysis: A Systematic Review and Meta-analysis

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ID: 331011
2026
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Abstract
Abstract Background Proximal hamstring avulsions can be technically challenging, particularly in chronic presentations where perineural scarring and sciatic nerve entrapment may contribute to persistent neuritic symptoms and functional limitation. Although sciatic nerve neurolysis is commonly performed at the time of repair, its clinical impact has not been comprehensively synthesized. Purpose To evaluate clinical outcomes and complications associated with sciatic nerve neurolysis performed during proximal hamstring tendon repair. Methods A PROSPERO-registered systematic review and meta-analysis queried PubMed, CINAHL, MEDLINE, and Cochrane through August 20, 2025, for studies reporting outcomes after proximal hamstring repair with concomitant sciatic nerve neurolysis. Chronicity definitions varied and included delayed surgery (mean approximately 3 years from injury) and established chronic pathology such as complete ruptures and apophyseal malunion or nonunion. The primary outcome was postoperative resolution or improvement of preoperative sciatic nerve related symptoms. Secondary outcomes included strength, patient-reported outcome measures, return to sport, satisfaction, and complications. Random-effects single-arm pooled proportions were calculated where feasible. Results Four Level IV retrospective case series met inclusion among 99 retrieved records, comprising 66 patients. Among symptomatic patients, pooled postoperative neurologic improvement was 0.82 (95% CI, 0.53–1.00; I2=0%). Strength improved when reported, including manual muscle testing (0–5 scale) increasing from 4.0 to 4.7 (p<0.001). Patient-reported outcomes were favorable, with median modified Harris Hip Scores approaching 90 and Hip Outcome Scores exceeding 90% in the apophyseal malunion/nonunion cohort; one series reported that all patients would elect to undergo surgery again. Return to sport was achieved in 18 of 24 patients (75%; 95% CI, 54.8–88.0). Complications were primarily minor and transient, including incisional numbness (31%) and transient neurapraxia (27%); re-exploration occurred in 7%. No permanent motor deficits were reported. Conclusion In the limited available literature, proximal hamstring repair with concomitant sciatic nerve neurolysis is associated with high rates of neuritic symptom improvement and favorable functional outcomes, with predominantly transient complications. Prospective comparative studies with standardized neurologic and hip-specific outcome measures are needed to define indications and quantify incremental benefit.
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Authors Bryan Soth, Joshua Robert Eskew, Antonio Madrazo-Ibarra, Alessandro Bensa, Emmett O'Malley, Alex Capitano, Todd McGrath, Duretti Teferi Fufa, Benedict Uchenna Nwachukwu, Nia J Baker
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.377
URL
https://doi.org/10.1093/jhps/hnag043.377
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