Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

Zantvoort, Aniek P. M. van; Bruijn, J. A. de; Hundscheid, Henricus P.H.; Cruijsen-Raaijmakers, Marike van der; Teijink, Joep A.W.; Scheltinga, Marc R.

doi:10.1055/a-0640-9104

Cited by 13 publications

(9 citation statements)

References 26 publications

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“…Beck et al 3 similarly noted that pediatric patients with isolated compartment release had higher rates of failure and reoperation than those with 4-compartment releases. van Zantvoort et al 34 evaluated resumption of sport activity specifically after isolated release of the lateral compartment for CECS and found that, of those who completed a questionnaire at 4 years postsurgery, 73% had returned to presurgery activity. Of those who returned, approximately 40% were at their presurgical level, while the remaining 60% were at a lower level of sport.…”

Section: Discussionmentioning

confidence: 99%

“…Of those who returned, approximately 40% were at their presurgical level, while the remaining 60% were at a lower level of sport. 34 Gatenby et al 8 similarly investigated outcomes after isolated anterolateral compartment release and reported that 90% of patients return to sports at the same or higher level postoperatively. This study similarly notes that patients who required revision surgery were often returning to the operating room to release compartments previously not released.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Specifics on the dynamic ICP measurement procedure of each of the 2 compartments have been published previously. 3,15…”

Section: Methodsmentioning

confidence: 99%

“…Specifics on the dynamic ICP measurement procedure of each of the 2 compartments have been published previously. 3,15 3 Groups of Anterolateral CECS Study patients were grouped on the basis of ICP results. The first ELP group (ant-CECS) had elevated ICP in the anterior compartment and normal ICP in the lateral compartment, the second group (lat-CECS) had elevated ICP in the lateral compartment and normal pressure in the anterior compartment, and the third group (ant-/lat-CECS) had elevated ICP in both the anterior and lateral compartments.…”

Section: Dynamic Icp Of 2 Compartments Simultaneouslymentioning

confidence: 99%

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Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

Zantvoort

Hundscheid

Bruijn

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the leg. It is generally accepted that CECS of the third or lateral compartment (lat-CECS) always occurs together with ant-CECS. However, whether exertional leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown. Purpose: To determine the existence of isolated lat-CECS and study whether history taking and a physical examination aid in discriminating between different subtypes of CECS. Study Design: Case series; Level of evidence, 4. Methods: Patients were eligible for this single-center study, conducted between January 2013 and February 2018, if they reported anterolateral ELP and completed a questionnaire scoring the frequency and intensity of pain, tightness, cramps, muscle weakness, and paresthesia during rest and exercise. They were asked to mark areas of altered foot skin sensation, if present, on a drawing. All patients underwent a dynamic intracompartmental pressure (ICP) measurement of the anterior and lateral compartments simultaneously. The diagnosis of CECS was confirmed by elevated ICP (Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with elevated ICP in the anterior compartment and normal ICP in the lateral compartment, (2) isolated lat-CECS with elevated ICP in the lateral compartment but normal ICP in the anterior compartment, and (3) ant-/lat-CECS with elevated ICP in both the anterior and lateral compartments. Results: A total of 73 patients with anterolateral ELP fulfilled study criteria (isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n = 42). Group differences were not observed regarding age (isolated ant-CECS: median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years [range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years]; χ2 (2) = 0.466; P = .79), sex (isolated ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male; P = .49), or bilateral symptoms (isolated ant-CECS: 54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40). However, cramps at rest were present in a portion of the patients with isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with isolated lat-CECS ( P = .032). Patient drawings of altered foot skin sensation did not contribute to the diagnosis ( P = .92). ICP values after provocation were all lower in patients with isolated ant-CECS and isolated lat-CECS compared with those with ant-/lat-CECS ( P < .05). Conclusion: Seven percent of patients with CECS and anterolateral ELP who had symptoms due to isolated lat-CECS in the presence of normal muscle pressure in the anterior compartment.

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Female patients have greater improvement in pain symptoms and physical activity after fasciotomy for treatment of chronic exertional compartment syndrome of the lower leg

Shankar,

Vasavada,

Gillinov

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to identify sex differences in postoperative outcomes and return‐to‐sport rates after fasciotomy for treatment of chronic exertional compartment syndrome (CECS) of the lower leg. It was hypothesised that male CECS patients would have a higher rate of return to sport than female CECS patients.MethodsA retrospective cohort study was conducted involving patients who underwent primary fasciotomy of one to four leg compartments for treatment of CECS at a single centre from 2010 to 2020. Each affected leg was treated as a separate subject. Postoperative outcomes included CECS pain frequency and severity, return to sport and Tegner activity level. Multivariable regression was used to determine if sex was an independent predictor of outcomes after adjusting for demographic and clinical covariates. p < 0.05 were considered significant.ResultsEighty‐one legs (44 M, 37 F) of 47 unique patients (34 of whom had bilateral symptoms) were included with a mean follow‐up time of 51.5 ± 31.4 months. Male subjects were older (p < 0.001) and had higher body mass index (p < 0.001) compared to female subjects. Most subjects (84.0%) underwent two‐ or four‐compartment fasciotomies. Female sex was found to be predictive of lower overall postoperative pain severity (p = 0.007), higher odds of return to sport (p = 0.04) and higher postoperative Tegner score (p = 0.005). However, female sex was not predictive of postoperative pain frequency, odds of reoperation or odds of return to sport to at least the presymptomatic level (all p < 0.05).ConclusionFemale sex is independently predictive of reduced overall pain severity, higher odds of return to sport and higher postoperative improvement in Tegner score following fasciotomy for treatment of lower‐limb CECS.Level of EvidenceIII.

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Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

Cited by 13 publications

References 26 publications

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

Female patients have greater improvement in pain symptoms and physical activity after fasciotomy for treatment of chronic exertional compartment syndrome of the lower leg

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