Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

Abstract

The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.

Fasciectomy for Recurrent Chronic Exertional Compartment Syndrome of the Anterior Leg

“…Patients often experience symptoms while performing repetitive physical activities such as running, ice skating, or soccer (1)(2)(3)(4)(5). The anterior compartment is most frequently involved (ant-CECS, 40%-77%), although the deep flexors (32%-60%) or peroneal (12%-35%) muscles may also be affected (6)(7)(8). Because physical performance and well-being are impaired, intervention is often desired.…”

The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome

“…Success (recorded as “good or excellent treatment effect”) was noted in 42% of the surgical cohort, but only 17% in the conservative treatment cohort. However, only 26% of the surgical cohort was able to achieve the prior level of sport, while 35% of the conservative treatment group was able to return to their prior level of sport (47).…”

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

“…3–5 The deep and superficial posterior compartments are less commonly involved; however, when present, can lead to less reliable response to surgical treatment. 5–7…”

“…6,7,10,11 Even after surgical treatment patients can experience continued pain, decreased functional outcome scores, and complications such as recurrence of CECS/continued postoperative pain, infection, or neurologic symptoms such as iatrogenic neuropraxia or neurotmesis of the superficial peroneal nerve (SPN) or CECS-induced nerve symptoms. 5,6,10…”