Surgical Management of Exertional Anterior Compartment Syndrome of the Leg

Ali, Terry; Mohammed, Fawwaz; Mencia, Marlon; Maharaj, Dale; Hoford, R

doi:10.7727/wimj.2006.135

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…Improvement of symptoms or satisfaction was reported by 47% (±42%) of the patients who completed a follow-up analysis, whereas 50% (±45%) returned to a form of physical activity. The well-structured gait retraining programs 20,23 and treatment with botulinum injections 22 scored highest with satisfaction rates ranging from 89% to 100%, whereas all studies with patients alone initiated modifications in activity and/or lifestyle 7,8,[24][25][26][27] scored between 0% and 84% satisfaction. Among the 171 conservatively treated patients, six cases were reported to eventually opt for surgery.…”

Section: Outcome Following Conservative Treatmentmentioning

confidence: 99%

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Vogels

Ritchie

Dongen

et al. 2020

Scandinavian Med Sci Sports

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Objective Surgery is the gold standard in the management of chronic exertional compartment syndrome (CECS) of the lower extremity, although recent studies also reported success following gait retraining. Outcome parameters are diverse, and reporting is not standardized. The aim of this systematic review was to analyze the current evidence regarding treatment outcome of CECS in the lower leg. Material and Methods A literature search and systematic analysis were performed according to the PRISMA criteria. Studies reporting on outcome following treatment of lower leg CECS were included. Results A total of 68 reports fulfilled study criteria (n =; 3783; age range 12‐70 year; 7:4 male‐to‐female ratio). Conservative interventions such as gait retraining (n =; 2) and botulinum injection (n =; 1) decreased ICP (truex- =; 68 mm Hg totruex- =; 32 mm Hg) and resulted in a 47% (±42%) rate of satisfaction and a 50% (±45%) rate of return to physical activity. Fasciotomy significantly decreased ICP (truex- =; 76 mm Hg to truex- =; 24 mm Hg) and was associated with an 85% (±13%) rate of satisfaction and an 80% (±17%) rate of return to activity. Return to activity was significantly more often achieved (P < .01) in surgically treated patients, except in one study favoring gait retraining in army personnel. Conclusion Surgical treatment of CECS in the lower leg results in higher rates of satisfaction and return to activity, compared to conservative treatment. However, the number of studies is limited and the level of evidence is low. Randomized controlled trials with multiple treatment arms and standardized outcome parameters are needed.

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Section: Outcome Following Conservative Treatmentmentioning

confidence: 99%

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Vogels

Ritchie

Dongen

et al. 2020

Scandinavian Med Sci Sports

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“…This cohort study compares treatment outcome as reflected by changes in cardinal symptoms, patient satisfaction, as well as return to physical activity. Similar differences in satisfaction favoring surgery were already demonstrated in most small cohorts [6,8,22,23]. However, an exact description of the methodology for determining satisfaction was often lacking.…”

Section: Discussionmentioning

confidence: 61%

“…The three different types of lower leg CECS, including combinations, were not separately evaluated. Our study design is different from previously published cohorts focusing on the anterior compartment only [22][23][24]. For instance, the study by Packer et al [23] found higher satisfaction rates in patients only receiving a fasciotomy for the anterior compartment compared to patients undergoing surgery for multiple compartments.…”

Section: Discussionmentioning

confidence: 63%

“…The choice for either conservative or surgical treatment for CECS is largely based on clinical experience but not on sound evidence. However, current literature appears to favor a surgical intervention, even though recent studies have shown successful conservative treatment in specific patient groups [6,8,18,[22][23][24][25]. In addition, most studies are biased due to small sample sizes and a high variety in outcome measurements.…”

Section: Introductionmentioning

confidence: 99%

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Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

et al. 2020

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The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.

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“…Cases required the following: symptoms of exercise-induced leg pain consistent with a diagnosis of anterior compartment CECS; no diagnosis other than CECS more likely; absence of multiple lower limb pathologies; and, no previous lower limb surgery. While intramuscular compartment pressure measurement is considered the gold standard for diagnosis (Roscoe, Roberts, & Hulse, 2015); clinical examination alone has been suggested to provide an accurate diagnosis for referral for surgery (Ali et al, 2013, Orlin, Oen, & Andersen, 2013, van den Brand et al, 2005. As pressure measurement was not available for this study, a clinical diagnosis was used.…”

Section: Methodsmentioning

confidence: 99%

Plantar pressure differences between cases with symptoms of clinically diagnosed chronic exertional compartment syndrome and asymptomatic controls

Roberts

Hulse

Bennett

et al. 2017

Clinical Biomechanics

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The lack of association with foottype-related and toe extensor activity-related plantar pressure variables suggest that these are not risk factors for the development of chronic exertional compartment syndrome, contrary to earlier hypotheses. The greater lateral to medial loading could theoretically represent increased Tibialis anterior muscle activity at heel strike but a subsequent loss of control as the ankle is lowered. Future studies directly investigating muscle activity and function are now required.

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Surgical Management of Exertional Anterior Compartment Syndrome of the Leg

Cited by 7 publications

References 10 publications

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

Plantar pressure differences between cases with symptoms of clinically diagnosed chronic exertional compartment syndrome and asymptomatic controls

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