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Endoscopic treatment of recalcitrant chronic exertional compartment syndromes (CECS) of the lower leg is rarely reported. Until now, endoscopic release of CECS of the lower leg is described in only 3 papers addressing 48 interventions in 30 patients. A systematic literature analysis was performed comparing endoscopic and minimally invasive lower leg CECS releases. No statistically relevant difference was found between the results of endoscopic (unweighted mean success rate=86.3%) and minimally invasive (unweighted mean success rate=80.0%) CECS release. However, the methodological quality of the analyzed studies is not sufficient and the number of endoscopically treated patients are too low to draw final conclusions.