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

Abstract

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.

The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome

“…For the deep posterior compartment, the target fasciotomy length was reached in 60% of specimens. While there is great potential with ultrasound, this procedure can be challenging to maintain optimal visualization and has not yet exhibited benefit in living subjects (46).…”

Chronic compartment-syndrome of the lower limb: modern strategies for diagnosis and treatment

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A Hybrid Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents—a Multi-center Pilot Program

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