Surgical Treatment of Chronic Exertional Compartment Syndrome of the Leg

Waterman, Cpt Brian R.; Laughlin, Cpt Matthew D.; Kilcoyne, Cpt Kelly; Cameron, Kenneth L.; Owens, Ltc Brett D.

doi:10.2106/jbjs.l.00481

Cited by 95 publications

(21 citation statements)

References 12 publications

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“…The percentage of patients requiring revision fasciotomy after release of all lower leg compartments has been reported in the literature to be as high as 20%. 21 , 24 This shows that requiring revision surgery is a relatively common outcome after release. By comparison, in this study, only 1 leg required revision anterolateral surgery.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome

Gatenby¹,

Haysom²,

Twaddle³

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Failure rates of up to 20% have been reported after fasciotomy for chronic exertional compartment syndrome (CECS). There is some evidence that postoperative failure and complication rates are higher in the posterior compartments of the lower leg than the anterolateral compartments. Isolated compartment surgery may put patients at risk of requiring revision surgery because of the risk of developing posterior compartment disease.Hypothesis:Isolated anterolateral fasciotomy for CECS, in the absence of posterior compartment symptoms, produces satisfactory functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2012, patients who had positive intracompartment pressure-testing findings and who underwent isolated anterolateral fasciotomy release for CECS were given a self-administered questionnaire. The minimum follow-up was 3 years. The questionnaire addressed time to return to sport and ongoing symptoms. A visual analog scale was used to assess pain during exercise before and after surgery (score: 0, no pain; 10, worst pain imaginable); overall satisfaction with the procedure was assessed as well. Of 31 eligible patients, 20 patients (36 legs operated on) were assessed.Results:Postoperatively, 90% of participants returned to the same or higher level of sport. The mean pain score during exercise before surgery was 8.17, whereas it was 1.74 after surgery. The overall mean patient satisfaction score was 8.64. Only 1 leg (2.8%) went on to develop posterior compartment syndrome.Conclusion:Isolated anterolateral fasciotomy for CECS produced excellent functional outcomes. Our rate of recurrence was low compared with those found in the literature, and 90% of participants returned to their same or higher level of sport postoperatively.

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Section: Discussionmentioning

confidence: 99%

Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome

Gatenby¹,

Haysom²,

Twaddle³

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…29 , 33 While the majority of patients do well after surgery, approximately 3% to 17% experience less than favorable outcomes such as pain, decreased sensation or hypersensitivity to touch at the incision site, paresthesia, infection, and hemorrhage. 7 , 13 , 19 , 30 , 37 Additionally, even individuals who do well initially may have a risk of symptom recurrence, which is reported to be as high as 50% over 5 years. These less favorable operative outcomes and the morbidity burden that postoperative rehabilitation has on military readiness gives great relevance to discovering alternative strategies for effective nonoperative CECS management.…”

mentioning

confidence: 99%

The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome

Helmhout

Diebal²,

Kaaden

et al. 2015

Orthopaedic Journal of Sports Medicine

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Background:Previous studies have reported on the promising effects of changing running style in patients with chronic exertional compartment syndrome (CECS) using a 6-week training program aimed at adopting a forefoot strike technique. This study expands that work by comparing a 6-week in-house, center-based run training program with a less extensive, supervised, home-based run training program (50% home training).Hypothesis:An alteration in running technique will lead to improvements in CECS complaints and running performance, with the less supervised program producing less dramatic results.Study Design:Cohort study; Level of evidence, 3.Methods:Nineteen patients with CECS were prospectively enrolled. Postrunning intracompartmental pressure (ICP), run performance, and self-reported questionnaires were taken for all patients at baseline and after 6 weeks of running intervention. Questionnaires were also taken from 14 patients (7 center-based, 6 home-based) 4 months posttreatment.Results:Significant improvement between preintervention and postintervention rates was found for running distance (43%), ICP values (36%), and scores on the questionnaires Single Assessment Numeric Evaluation (SANE; 36%), Lower Leg Outcome Survey (LLOS; 18%), and Patient Specific Complaints (PSC; 60%). The mean posttreatment score on the Global Rating of Change (GROC) was between +4 and +5 (“somewhat better” to “moderately better”). In 14 participants (74%), no elevation of pain was reported posttreatment, compared with 3 participants (16%) at baseline; in all these cases, the running test was aborted because of a lack of cardiorespiratory fitness. Self-reported scores continued to improve 4 months after the end of the intervention program, with mean improvement rates of 48% (SANE), 26% (LLOS), and 81% (PSC). The mean GROC score improved to +6 points (“a great deal better”).Conclusion:In 19 patients diagnosed with CECS, a 6-week forefoot running intervention performed in both a center-based and home-based training setting led to decreased postrunning lower leg ICP values, improved running performances, and self-assessed leg condition. The influence of training group was not statistically significant. Overall, this is a promising finding, taking into consideration the significantly reduced investments in time and resources needed for the home-based program.

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“…One study looking at a population of military men under extreme physical demand showed persistence of symptoms to some degree in up to 50% of patients. This study, also found that surgical revision may be needed in up to 6% of patients [ 15 ]. This study highlighted the high physical demand and increased body weight due to carrying equipment, yet patients experienced an 80% successful return to activity.…”

Section: Discussionmentioning

confidence: 89%

“…Surgical results are better in CECS cases involving the lateral and anterior compartments when compared to posterior compartments [ 12 , 13 ]. Fasciotomy is effective in the treatment of CECS with a success rate of 80% or greater [ 3 , 8 , 14 , 15 ]. One study looking at a population of military men under extreme physical demand showed persistence of symptoms to some degree in up to 50% of patients.…”

Section: Discussionmentioning

confidence: 99%

Chronic Exertional Compartment Syndrome in a High School Soccer Player

Bresnahan

Hennrikus

2015

Case Reports in Orthopedics

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Chronic exertional compartment syndrome (CECS) is a relatively rare condition that affects young adult athletes and often causes them to present to the emergency department. If left untreated, those who continue to compete at high levels may experience debilitating leg pain. Physicians may have difficulty differentiating CECS from other syndromes of the lower leg such as medial tibial stress syndrome, stress fractures, and popliteal artery entrapment. The gold standard for diagnosing CECS is intramuscular compartment pressure monitoring before and/or after 10 minutes of exercise. Some patients may choose to stop participation in sports in order to relieve their pain, which otherwise does not respond well to nonoperative treatments. In patients who wish to continue to participate in sports and live an active life, fasciotomy provides relief in 80% or more. The typical athlete can return to training in about 8 weeks. This is a case of a high school soccer player who stopped competing due to chronic exertional compartment syndrome. She had a fascial hernia, resting intramuscular pressure of 30 mmHg, and postexercise intramuscular pressure of 99 mmHg. Following fasciotomy she experienced considerable life improvement and is once again training and playing soccer without symptoms.

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Surgical Treatment of Chronic Exertional Compartment Syndrome of the Leg

Abstract: Chronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment.

Cited by 95 publications

References 12 publications

Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome

Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome

The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome

Chronic Exertional Compartment Syndrome in a High School Soccer Player

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