Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort

Tam, Johnson Pok-Him; Gibson, A. G. F.; Murray, James R. D.; Hassaballa, M

doi:10.1007/s00590-018-2299-3

Cited by 16 publications

(16 citation statements)

References 33 publications

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“…6 While results of a recent study suggested that injections of botulinum toxin may reduce intracompartmental pressure and episodes of pain with CECS, 13 the clinical application of this concept remains in its infancy. Instead, fasciotomy of the involved compartments has been increasingly utilized, with significant improvement in pain 29 and overall satisfaction rates ranging from 75% to 90%. 4,5,9,12,17,25 Despite relatively high satisfaction, good to excellent postoperative functional outcome measures have been reported in as few as 33% and as high as 98% of patients, based on several small series and subgroups.…”

mentioning

confidence: 99%

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Salzler

Maguire

Heyworth

et al. 2020

Sports Health: A Multidisciplinary Approach

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Background: Chronic exertional compartment syndrome (CECS) is primarily seen in running athletes. Previous outcomes of surgical treatment with fasciotomy have suggested moderate pain relief, but evidence is lacking regarding postoperative return to running. Hypothesis: Running athletes with limiting symptoms of CECS will show high rates of return to running after fasciotomy. Study Design: Case series. Level of Evidence: Level 4. Methods: Running athletes treated with fasciotomy for CECS at a single institution were identified using a surgical database and asked to complete a questionnaire designed to assess postoperative pain, activity level, return to running, running distances, overall satisfaction, and rate of revision fasciotomy. Results: A total of 43 runners met the inclusion criteria, and 32 runners completed outcomes questionnaires at a mean postoperative follow-up of 66 months. In total, 27 of these 32 patients (84%) returned to sport(s) after fasciotomy. However, 9 (28%) of these patients pursued nonrunning sports, 5 (16%) due to recurrent pain with running. Of the 18 patients who returned to running sports (56%), the mean weekly running distance decreased postoperatively. Recurrence of symptoms was reported in 6 patients (19%), 4 of whom had returned to running and 2 of whom had been unable to return to sports. All of these 6 patients elected to undergo revision fasciotomy surgery. Twenty-five (78.1%) patients reported being satisfied with their procedure. In the overall cohort, the mean visual analog scale scores for pain during activities/sports decreased from 7.9 preoperatively to 1.7 postoperatively. Conclusion: Fasciotomy for CECS in runners may provide significant improvement in pain and satisfaction in over three-quarters of patients and return to sports in 84% of patients. However, only 56% returned to competitive running activity, with a subset (19%) developing recurrent symptoms resulting in revision surgery. Clinical Relevance: Fasciotomy has been shown to decrease pain in most patients with CECS. This study provides outcomes in running athletes after fasciotomy for CECS with regard to return to sports, maintenance of sports performance, and rates of revision surgery.

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confidence: 99%

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Salzler

Maguire

Heyworth

et al. 2020

Sports Health: A Multidisciplinary Approach

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“…Given that a patient may injure another area of their body within that time frame, only the lower-limb portion of the deployability status was considered. One year has been recommended as the optimal follow-up time given that it allows sufficient time to recover from surgery, as well as enabling the identification of re-occurrences 47 , 48 . Deployability status was assessed by a local medical officer or the occupational medical board and judged against the UK Joint Service Medical Deployment Standards (JSP-950).…”

Section: Methodsmentioning

confidence: 99%

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Houston

Cosma

Turner³

et al. 2021

Sci Rep

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Chronic exertional compartment syndrome (CECS) is a condition occurring most frequently in the lower limbs and often requires corrective surgery to alleviate symptoms. Amongst military personnel, the success rates of this surgery can be as low as 20%, presenting a challenge in determining whether surgery is worthwhile. In this study, the data of 132 fasciotomies for CECS was analysed and using combinatorial feature selection methods, coupled with input from clinicians, identified a set of key clinical features contributing to the occupational outcomes of surgery. Features were utilised to develop a machine learning model for predicting return-to-work outcomes 12-months post-surgery. An AUC of 0.85 ± 0.08 was achieved using a linear-SVM, trained using 6 features (height, mean arterial pressure, pre-surgical score on the exercise-induced leg pain questionnaire, time from initial presentation to surgery, and whether a patient had received a prior surgery for CECS). To facilitate trust and transparency, interrogation strategies were used to identify reasons why certain patients were misclassified, using instance hardness measures. Model interrogation revealed that patient difficulty was associated with an overlap in the clinical characteristics of surgical outcomes, which was best handled by XGBoost and SVM-based models. The methodology was compiled into a machine learning framework, termed AITIA, which can be applied to other clinical problems. AITIA extends the typical machine learning pipeline, integrating the proposed interrogation strategy, allowing to user to reason and decide whether to trust the developed model based on the sensibility of its decision-making.

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“…In fact, virtually all studies mention return to sports, or return to full activity in soldiers. It appears that most patients are able to regain sports following surgery, 18,30,44 although the number of patients who experienced full recovery without any residual symptoms is lower. 26,42,45 In active military personnel, these numbers are even more restricted.…”

Section: Discussionmentioning

confidence: 99%

“…As such, complication rates are often not reported. 30 , 44 , 45 In studies that have reported complication rates, up to 25% were found. 9 , 12 , 21 , 24 , 26 , 38 , 43 These include minor complications such as hematomas or superficial wound infections, but also major ones requiring reintervention (e.g., deep wound infection or major bleeding) or superficial peroneal nerve (SPN) injury.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg

Bruijn

Zantvoort

Hundscheid

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) of the anterior leg compartment (ant-CECS) is frequently treated with a minimally invasive fasciotomy. Several operative techniques and operative devices exist, but none have been compared in a systematic and randomized manner. Purpose: To compare efficacy, safety, and postoperative pain of a novel operative device (FascioMax fasciotome) with a widely accepted device created by Due and Nordstrand (Due fasciotome) during a minimally invasive fasciotomy for ant-CECS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with bilateral isolated ant-CECS between October 2013 and April 2018 underwent a minimally invasive fasciotomy using the FascioMax fasciotome in 1 leg and the Due fasciotome in the contralateral leg in a single operative session. Symptom reduction at 3 to 6 months and >1 year, postoperative pain within the first 2 weeks, peri- and postoperative complications, and ability to regain sports were assessed using diaries, physical examination, and timed questionnaires. Results: Included in the study were 50 patients (66% female; median age, 22 years [range, 18-65 years]). No differences between the devices were found in terms of perioperative complications (both had none), minor postoperative complications including hematoma and superficial wound infection (overall complication rate: FascioMax, 8% vs Due, 6%), or reduction of CECS-associated symptoms at rest and during exercise. At long-term follow-up (>1 year), 82% of the patients were able to regain their desired type of sport, and 67% (33/49) were able to exercise at a level that was comparable with or higher than before their CECS-associated symptoms started. Conclusion: Both the FascioMax and the Due performed similarly in terms of efficacy, safety, and levels of pain within the first 2 weeks postoperatively. Registration: NL4274; Netherlands Trial Register.

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Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort

Abstract: Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.

Cited by 16 publications

References 33 publications

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg

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