Fasciotomy for Deep Posterior Compartment Syndrome in the Lower Leg

Winkes, Michiel B.; Zantvoort, Aniek P. M. van; Bruijn, J. A. de; Smeets, S.J.M.; Cruijsen-Raaijmakers, Marike van der; Hoogeveen, Adwin R.; Scheltinga, Marc R.

doi:10.1177/0363546515626540

Cited by 40 publications

(46 citation statements)

References 25 publications

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“…Just half of all operated CECS patients returned to sports practice in one study [14]. One other study of operated dp-CECS patients reported that only 38 % returned to preinjury levels and 41 % performed at lower levels [28]. The present study found that only 30 % were able to resume sports activities at a similar level compared to their preoperative condition, whereas the remaining 70 % performed at a lower level than previously.…”

Section: Discussioncontrasting

confidence: 41%

Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

et al. 2018

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Exercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). Anterior or deep posterior compartments are usually affected. Knowledge about CECS of the lateral compartment (lat-CECS) is limited and outcome after fasciotomy is unknown. The purpose of this study is to report on success rates of fasciotomy in patients with lat-CECS. Surgical success rates in patients with lat-CECS diagnosed with a dynamic intracompartmental pressure (ICP) measurement were studied using a questionnaire (success: excellent or good as judged by the patient; unsuccessful: moderate, fair or poor). We conducted ICP measurements in 247 patients for suspected lat-CECS, of whom 78 were positively diagnosed. Following exclusion (n=11), 30 of the eligible 67 patients completed the questionnaire. Bilateral (70%, n=21/30) exertional pain (97%, n=29) and a feeling of tightness (93%, n=28) were the most frequently reported symptoms. Four years after fasciotomy, severity and frequency of symptoms had dropped significantly. Long-term surgical success was reported by 33% (n=10; excellent n=4, good n=6). Seventy-three percent (n=22) had resumed sports activities (9 same level, 13 lower level). In conclusion, a fasciotomy for lat-CECS was successful in the long term in just one of three operated patients in this retrospective study.

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Section: Discussioncontrasting

confidence: 41%

Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

et al. 2018

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“…4,20,30 A “fifth compartment” consisting of the tibialis posterior muscle with its own fascia that is left intact during the surgical exploration probably also contributes to an inferior outcome after surgery in patients with dp-CECS. 18,41 In our opinion, a surgeon should always explore all muscles of the affected compartment to make sure the fasciotomy is complete.…”

Section: Discussionmentioning

confidence: 99%

Role of Repeat Muscle Compartment Pressure Measurements in Chronic Exertional Compartment Syndrome of the Lower Leg

Zantvoort

Bruijn

Winkes

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The diagnostic gold standard for diagnosing chronic exertional compartment syndrome (CECS) is a dynamic intracompartmental pressure (ICP) measurement of the muscle. The potential role of a repeat ICP (re-ICP) measurement in patients with persistent lower leg symptoms after surgical decompression or with ongoing symptoms after an earlier normal ICP is unknown.Purpose:To study whether re-ICP measurements in patients with persistent CECS-like symptoms of the lower leg may contribute to the diagnosis of CECS after both surgical decompression and a previously normal ICP measurement.Study Design:Case series; Level of evidence, 4.Methods:Charts of patients who underwent re-ICP measurement of lower leg compartments (anterior [ant], deep posterior [dp], and/or lateral [lat] compartments) between 2001 and 2013 were retrospectively studied. CECS was diagnosed on the basis of generally accepted cutoff pressures for newly onset CECS (Pedowitz criteria: ICP at rest ≥15 mmHg, ≥30 mmHg after 1 minute, or ≥20 mmHg 5 minutes after a provocative test). Factors predicting recurrent CECS after surgery or after a previously normal ICP measurement were analyzed.Results:A total of 1714 ICP measurements were taken in 1513 patients with suspected CECS over a 13-year observation period. In all, 201 (12%) tests were re-ICP measurements for persistent lower leg symptoms. Based on the proposed ICP cutoff values, CECS recurrence was diagnosed in 16 of 62 previously operated compartments (recurrence rate, 26%; 53 patients [64% female]; median age, 24 years; age range, 15-78 years). Recurrence rates were not different among the 3 lower leg CECS compartments (ant-CECS, 17%; dp-CECS, 33%; lat-CECS, 30%; χ2 = 1.928, P = .381). Sex (χ2 = 0.058, P = .810), age (U = 378, z = 1.840, P = .066), bilaterality (χ2 = 0.019, P = .889), and prefasciotomy ICP did not predict recurrence. Re-ICP measurements evaluating 20 compartments with previously normal ICP measurements (15 patients [53% female]; mean age, 31 ± 10 years) detected CECS in 3 compartments (15%, all ant-CECS).Conclusion:Previous fasciotomy for lower leg CECS or previously normal muscle pressure (ICP) do not rule out CECS as a cause of persisting lower leg symptoms. Repeat ICP measurement may have a potential role in the evaluation of patients with persistent lower leg complaints. However, other reasons for lower leg exertional pain must always be considered prior to secondary surgery.

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“…One of the most utilised is that developed by Mubarak [16]: a fasciotomy of the anterior and lateral compartments via a 10cm incision. While newer techniques are mini-invasive either via an endoscopic or cutaneous mini-accesses [9][10][11][12][13][14][15][16][17]. These more modern approaches produce results similar to those of interventions using more ample accesses [18].…”

Section: Discussionmentioning

confidence: 99%

Chronic Compartment Syndrome of Lower Leg. An Unusual Case in Non Athletic Patient

Schiavone¹,

Bisaccia²,

Meccariello³

et al. 2016

IJSM

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Chronic exertional anterior compartment syndrome is debilitating disease of the lower limb. Limited symptomology characterises the clinical picture at rest, pain during sporting activities, tumefaction, and contractures of the limb as well impotency by the pain of the entire forefoot and hypoesthesia. Usually, the most affected patients are athletes. We analyse a case of chronic post-traumatic compartment syndrome of the anterior tibial muscle in an unsportsmanlike patient.

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Fasciotomy for Deep Posterior Compartment Syndrome in the Lower Leg

Abstract: Fasciotomy was beneficial in 71% of patients with dp-CECS in the lower leg; 47% of study patients experienced a good to excellent outcome. Outcomes were stable in the long term. Persistent complaints were often caused by other untreated conditions.

Cited by 40 publications

References 25 publications

Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

Role of Repeat Muscle Compartment Pressure Measurements in Chronic Exertional Compartment Syndrome of the Lower Leg

Chronic Compartment Syndrome of Lower Leg. An Unusual Case in Non Athletic Patient

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