Lower Leg Muscle Hernia: A Systematic Review

Abstract

Background:The review aims to review the published literature on lower leg muscle hernias.Methods: A systematic review was conducted according to PRISMA guidelines. All studies that reported on lower leg muscle herniation were included.Results: Lower leg muscle herniation occurs in predominantly males at an average age of 28.8 years (SD, 3.4 years). Most patients reported history of manual labour or sporting activities. The anterior compartment is predominantly affected (78.9%), followed by the lateral compartment (10.5%) and the superficial posterior compartment (10.5%). Tibialis anterior muscle herniation was predominantly found in younger patients (< 35 years old), as compared to older patients (>35 years old) who experienced herniation of varying muscles (e.g. soleus, peroneus, gastrocnemius). Fascial weakening at the point of muscle herniation was detected in 36.8% of included patients. Surgical management was performed in 78.9% of the patients, with the predominant surgery performed being fasciotomy, though recent reports also reported good outcomes with surgical repair in the presence of fascial defects in the lower limb without evidence of compartment syndrome. Resolution of symptoms (pain, muscle protuberance) and return to pre-herniation level of physical activities was reported in all studies.Conclusions: Lower leg muscle herniation predominantly affects males in the third decade of life who are involved in manual labour or sporting activities. These predominantly affect the anterior compartment, with tibialis anterior being the predominant muscle involved in younger patients. Surgical management of both fasciotomy and surgical repair has led to good outcomes.