Sciatic nerve injury after hip arthroscopy in a patient with marked hamstring tightness: a case report and narrative review

Abstract Background Sciatic nerve injury is an uncommon but potentially serious complication of hip arthroscopy. Reduced hamstring flexibility has been associated with greater resistance to hip distraction, but clinical observations linking preoperative hamstring tightness, difficult distraction, and postoperative sciatic neuropathy are limited. Case presentation: An 18-year-old man with femoroacetabular impingement and an acetabular labral tear had marked preoperative hamstring tightness, with a passive straight-leg raise of 41°, an active knee extension angle of approximately 130°, and a popliteal angle of 50°. Preoperative neurological examination was normal. Initial joint distraction during arthroscopic labral repair, acetabuloplasty, and femoroplasty was inadequate and required stepwise increases in traction. Total traction time was approximately 70 minutes; the applied force was not quantitatively recorded. Severe sensory and motor deficits developed immediately after surgery. Ultrasonography at 1 month showed focal sciatic nerve thickening, and electromyography at 3 months demonstrated severe proximal sciatic neuropathy. Following ankle-foot orthosis use and rehabilitation, ankle dorsiflexion and plantar flexion recovered to grades 4 + and 5, respectively, at 1 year, while sensory recovery remained incomplete. Literature review: A narrative search of PubMed and Web of Science through August 27, 2026 identified 19 eligible original clinical studies, 14 reporting sciatic or named-branch nerve injuries and five reporting no target events. Reported proportions ranged from 0.04% to 19.1%, reflecting heterogeneous populations and ascertainment. Evidence linking nerve injury to traction magnitude and duration was inconsistent. Conclusions This case documents the clinical sequence of marked preoperative hamstring tightness, difficult hip distraction requiring increased traction, and severe postoperative sciatic nerve injury. Hamstring tightness may be a warning feature for increased distraction resistance and possible neural vulnerability. Preoperative flexibility assessment and individualized traction management merit consideration. This observation supports further investigation of the association without establishing causality.