Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Salzler, Matthew J.; Maguire, Kathleen; Heyworth, Benton E.; Nasreddine, Adam Y.; Micheli, Lyle J.; Kocher, Mininder S.

doi:10.1177/1941738120907897

Cited by 12 publications

(9 citation statements)

References 36 publications

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“…The overall satisfaction rate (77%) obtained in the present study falls within the range of earlier studies, which found patient-reported satisfaction rates 10 , 21 , 23 , 27 of 76% to 81%. However, these earlier studies included patients with varied combinations of compartments treated with fasciotomy for CECS; thus, the results might not be comparable.…”

Section: Discussionsupporting

confidence: 88%

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Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Lindorsson

Zhang

Brisby

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) causes exercise-induced leg pain. The diagnosis is confirmed by intramuscular pressure (IMP) measurements. Fasciotomy has been demonstrated to be a successful treatment for CECS; however, few studies have examined postoperative IMP and long-term outcomes. Purpose: To evaluate long-term outcomes and postoperative IMP in patients surgically treated for anterior CECS, and to identify possible preoperative or postoperative factors associated with overall satisfaction with treatment at follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive series of 209 patients who underwent fasciotomy of the anterior compartment for CECS between 2009 and 2019 and had at least 1 year of follow-up were approached for inclusion. A total of 144 patients (69%), with a follow-up time of 1 to 11.5 years, were ultimately included. All patients underwent preoperative and postoperative 1-minute postexercise IMP measurements of the anterior compartment and completed a questionnaire covering pain and activity parameters at both time points. The follow-up questionnaire included an additional question on overall satisfaction with treatment, and surgical details were collected from the patient’s medical records. Results: The median IMP was significantly lower at follow-up than at baseline (17 mm Hg [range, 5-91 mm Hg] vs 49 mm Hg [range, 25-130 mm Hg]; P < .001). The overall satisfaction rate was 77%, and 83% reported a decreased pain level. The group of patients who were satisfied with the treatment included more men and had a higher ΔIMP and a lower revision rate ( P < .05). Among the 16 patients (11%) who had undergone revision fasciotomies before follow-up, the satisfaction rate was 56%, and 64% reported a decrease in pain level. Conclusion: Fasciotomy significantly reduced 1-minute postexercise IMP in patients with CECS and resulted in satisfaction and decreased pain in more than three-quarters of the patients at long-term follow-up. The male sex and a significant decrease in IMP were both positively associated with treatment satisfaction. Patients who underwent revision surgery before the follow-up had lower satisfaction rates and less pain reduction than the overall group.

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Section: Discussionsupporting

confidence: 88%

“…The follow-up time ranged from 1 to 11.5 years, which is comparable to some of the previous studies investigating treatment results for patients with CECS. 18 , 21 , 27 , 28 However, these previous studies all had a completely retrospective design regarding baseline data, thus introducing recall bias to the results.…”

Section: Discussionmentioning

confidence: 99%

Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Lindorsson

Zhang

Brisby

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…Surgical interventions in the form of compartment-specific fasciotomies have become a prominent method of treating CECS 8 , 9 . Whilst fasciotomies have proven successful amongst civilian populations, enabling more than 75% of athletes to return to sport 10 – 15 , the same cannot be said for military personnel who have been described as having less reliable outcomes 16 . Audits suggest that less than 45% of UK military personnel manage to return to a fully-fit state 17 , with most recent evidence showing this number to be as low as 22% 18 .…”

Section: Introductionmentioning

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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“…Further minor evidence showed that runners are less likely than other athletes to return to their chosen sport after fasciotomy. 10 Linear regression analysis of the CoSy score (R 2 ¼ 0.61) suggested a good predictive element for a high score and better pain reduction after fasciotomy. The correlation data also suggested that the cutoff score for a positive outcome is likely 4.…”

Section: Discussionmentioning

confidence: 96%

“…Further minor evidence showed that runners are less likely than other athletes to return to their chosen sport after fasciotomy. 10 …”

Section: Discussionmentioning

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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Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

Cited by 12 publications

References 36 publications

Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

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

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

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