Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

Dai, Amos Z.; Zacchilli, Michael A.; Jejurikar, Neha; Pham, Hien; Jazrawi, Laith M.

doi:10.1016/j.eats.2017.08.014

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…The medial location of the neurovascular structures, which crossed the cephalad end of the planned fasciotomy path, resulted in premature discontinuation of the procedure in one case. Our starting location (approximately 2 cm posterior/lateral to the medial tibial crest, Figure 2) was chosen in part based on the starting location noted in several prior studies 12‐16 . A more anteromedial start location may have facilitated a path around the neurovascular bundle and allowed for achievement of the target distance in that cadaveric specimen.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

Reisner

Noble-Taylor

Cummings

et al. 2020

PM&R

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Background Chronic exertional compartment syndrome (CECS) is a type of leg pain related to elevated intracompartmental pressure with activity in one or more of the four compartments of the leg. Open fasciotomy is the definitive treatment for CECS but has a reported complication rate of up to 15.7% and return to full activity reported up to 16 weeks. Ultrasound‐guided (USG) fasciotomy of the anterior and lateral compartments has been translated into clinical practice. Objective To determine the safety and feasibility of a USG fasciotomy of the deep posterior compartment (DPC) and superficial compartment (SPC) of the leg in a fresh‐frozen cadaveric model. Design Prospective, cadaveric laboratory investigation. Setting Procedural skills laboratory at an academic institution. Cadaveric Cohort Ten fresh‐frozen cadaveric knee‐ankle‐foot specimens from five female and five male donors aged 58 to 93 years (mean 77.4 years) with body mass indexes of 18.1 to 33.5 kg/m2 (mean 25.1 kg/m2). Methods or Interventions One experienced operator performed 10 USG DPC and SPC fasciotomies. A clinical anatomist performed dissections of each. Main Outcome Measures Achievement of target length and continuity of release was recorded. Target lengths of 10 cm for the superficial posterior compartment (SPC) and 15 cm for the deep posterior compartment (DPC) were established based on previous studies. Tendinous and neurovascular structures were assessed for damage. Results No tendon or neurovascular injuries were observed. In the SPC, target length was achieved in 90% and continuous release was observed in 80%. In the DPC, target length was achieved in 60% and continuity observed in 30%. Conclusions These findings suggest that SPC USG fasciotomies using the technique described in this study are feasible, may be safe, and warrant further translational research; however, DPC USG fasciotomies are more challenging and require more technical refinement prior to clinical translation.

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Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

Reisner

Noble-Taylor

Cummings

et al. 2020

PM&R

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“…There is a possibility of recurrence of ECS in affected compartments of about 6 to 11%, which will be evaluated for a second fasciotomy procedure 9 . Although results vary in substantial ranges, a recent systematic review on fasciotomy for ECS concluded an overall success rate of 66%, satisfaction rate of 84% as well as return to full activity of 75% 19 . Each percentage is a significant amount over 50%, which concludes it to be overall successful in each aspect.…”

Section: Diagnosis and Treatment Of Exertional Compartment Syndromementioning

confidence: 99%

Exertional Compartment Syndrome and the Development of Preventative Measures

Mulvey

2024

Preprint

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Throughout this paper the effects of injuries on athletes are highlighted in different aspects. Exertional compartment syndrome is a specific injury related to athletes that is thoroughly explored in this paper through an analysis of the anatomy, symptoms, diagnosis and treatments of the syndrome. Exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling as well as disability in the affected muscles of the lower leg. This syndrome commonly develops in young athletes involved in sports with excessive running and repetitive impact such as track and field, soccer, basketball and lacrosse. Exertional compartment syndrome is commonly misdiagnosed as other less severe injuries such as shin splints, which is symptomatic of pain along the tibia bone of the lower leg caused by overuse. The misdiagnosis of exertional compartment syndrome allows the syndrome to worsen and intensify resulting in the only effective treatment to be fasciotomy, a surgical procedure to release the pressure within the compartment of the lower leg. There is no definitive protocol developed for patients after fasciotomy is performed. Athletes experiencing similar symptoms after surgery are usually treated for their symptoms rather than the syndrome as a whole, which does not have a high degree of success. The development of a definitive protocol utilizing the techniques of manual therapy, mobility stretching and corrective strength training can improve the adverse effects of exertional compartment syndrome as well as restore functionality to the athlete. Raising awareness of this syndrome in athletics will be effective in treating the athlete early on in order to avoid severe effects and invasive procedures.

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“…Fasciotomy is now a standardized procedure with techniques well described in the literature. 3 , 12 The technique is reproducible, with the main risks being nerve injuries, incomplete release, or wound complications. 2 It is, therefore, our view that the failure of surgery is more likely to be related to patient selection rather than the surgical procedure itself.…”

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confidence: 99%

Predictors of Positive Outcomes and a Scoring System to Guide Management After Fasciotomy for Chronic Exertional Compartment Syndrome

Trew

Kocialkowski

Parsons

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) of the lower limb usually responds well to fasciotomy in patients with failed nonoperative treatment. Careful history taking and compartment pressure testing are both required to accurately diagnose CECS. Purposes: To evaluate patients with CECS after fasciotomy to establish predictive criteria of positive outcomes and to develop a scoring system to aid clinicians in their management of such patients. Study Design: Case-control study; Level of evidence, 3. Methods: We reviewed data from 28 patients who underwent fasciotomy between 2017 and 2019. All patients had undergone preoperative dynamic intracompartmental pressure (ICP) monitoring. For each patient, subjective preoperative and postoperative pain scores were gained via a questionnaire. The point biserial and Pearson correlation coefficients were used to calculate the association between multiple diagnostic criteria and a reduction in visual analog scale (VAS) pain scores after fasciotomy. Results: A reduction in VAS pain scores was strongly correlated with a peak ICP >40 mm Hg ( r = 0.71; P = .0007) and an area under the receiver operating characteristic curve for an intraexercise ICP >22,000 mm Hg·s2 ( r = 0.76; P = .0002). A moderate correlation was found between a history of CECS pain ( r = 0.61; P = .005), a duration of symptoms of <30 minutes after stopping exercise ( r = 0.60; P = .006), and a gradient in the intraexercise ICP >10 mm Hg ( r = 0.60; P = .006). When combined into an objective, weighted scoring system (2 points for factors with r > 0.7; 1 point for r = 0.5-0.7), a score of ≥4 points (of 7) had a strong correlation ( r = 0.85; P < .00001) with postoperative improvement in the VAS pain score. Linear regression of this score demonstrated a good fit ( R 2 = 0.61; P < .0001), indicating a degree of predictive power. Conclusion: We identified diagnostic criteria in the history and examination of patients with CECS that can be used to help predict positive outcomes after fasciotomy. We propose a scoring system to aid clinicians in their management of such patients. We recommend taking these results forward in prospective trials to test the efficacy of predictive scoring.

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Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

Cited by 9 publications

References 23 publications

Ultrasound‐Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

Ultrasound‐Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

Exertional Compartment Syndrome and the Development of Preventative Measures

Predictors of Positive Outcomes and a Scoring System to Guide Management After Fasciotomy for Chronic Exertional Compartment Syndrome

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