Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

Abstract

Knowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20-25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

Features of Chronic Exertional Compartmental Syndrome of the Leg in Elite Nordic Skiers

“…Some authors suggested that CECS may develop early during the athlete's sports career [14,15]. The level of practice may also influence the risk of CECS in Nordic skiers, elite skiers being more likely to develop CECS [16,17,19].…”

“…This value is relatively similar to the prevalence measured in the present study, but it could be overestimated since these authors based their diagnosis of CECS on symptoms only. Indeed, De Bruijn et al [14] showed that about 50 % of patients who had leg pain had normal intra-compartmental pressure. Waterman et al [24] measured the incidence of CECS in a military population between 2006 and 2011.…”

“…These previous studies focused, however, on the general population and on non-elite athletes older than the present population. Recently, De Bruijn et al [14] found that the prevalence of CECS peaked around 20-25 years old in their active patient population. Three studies [15,29,30] investigated CECS in younger athletes and showed that surgery occurred at a mean age of 17 [29] and 20 [30] and that the first CECS symptoms occurred at the age of 15.2 [15].…”

“…The prevalence of CECS is estimated at 7.6 % in the general population [5], and ranges from 10-60 % in populations of athletes with exercise-induced leg pain [6][7][8][9]. CECS is observed in sports involving endurance (middle and long distance) or intermittent (especially field games, football for instance) running [1,3,6,[10][11][12][13] and skating [14,15]. The population of Nordic skiers (cross-country skiers and biathletes) has also been reported to be at risk for CECS [8,[16][17][18][19], but to date, CECS prevalence in Nordic skiers remains unknown.…”

Exercise-induced leg pain syndromes

“…Interestingly, the incidence of CECS in general populations nowadays is increasing. A recent study in an ELP referral center found that one in eight individuals with CECS was a civilian over 50 years of age [4]. This trend of higher incidences of ELP in general populations is likely due to the 'exercise is medicine' movement that is currently embraced by large groups of active senior persons having sufficient spare leisure time.…”