Tibial anterior compartment compressibility in healthy subject, measured using compression sonography

Abstract

Introduction: Compression sonography has been introduced for non-invasive measurement of compartment compressibility and possible diagnostic tool for acute or chronic compartment syndrome in studies using human cadavers and animal models.To date, standard values in healthy subjects are not yet defined. The aim was to define standard compartment compressibility values in healthy human subjects and to assess the reliability of this measurement method. Methods: In 60 healthy volunteers, using ultrasound, the diameter of the tibial anterior compartment was measured while applying no pressure, 10mbar and 80mbar of external pressure. A pressure manometer on the ultrasound head was used to monitor the externally applied pressure. Compartment compressibility ratio (R 0-80 , respectively R 10-80 ) was calculated as following: The delta of the compartment diameter with high and low external pressure, divided through the diameter with low external pressure. In 10 volunteers, two examinators conducted each two measurements to assess the reliability. Results: Mean compartment compressibility ratio R 10-80 was 15.9% ±3.6 (range: 7.2 -22.2). Mean compartment compressibility ratio R 0-80 was 18.2% ±5.0 (3.0 -32.1). There was no significant correlation with lower leg circumference, height, weight, BMI, gender, hours of sport per week and type of sport (e.g. weightlifting/ cardio).For R 10-80 , intraobserver ICC 2.1 was 0.89 for an experienced observer and 0.79 for a non-experienced observer. Interobserver ICC 2.1 was 0.78. For R 0-80 , intraobserver ICC 2.1 was 0.71 for the experienced and 0.56 for the unexperienced observer. Interobserver ICC 2.1 was 0.59. Discussion: In healthy volunteers between 18 and 50 years of age, mean compartment compressibility ratio R 10-80 was 15.9% ±3.6, independent of demographic factors and sport activity. Application of 10mbar instead of 0mbar increased image quality. Subsequently, R 10-80 showed lower standard deviation and both higher intraobserver and interobserver reliability than R 0-80 . Using R 10-80 , this measurement method is reliable with very high intra-and interobserver correlation.

Review of Reliable and Valid Noninvasive Tools for the Diagnosis of Chronic Exertional Compartment Syndrome

“… 4 Anwander et al showed that measurement of the anterior compartment compressibility ratio by compression sonography had high intraobserver and interobserver reliability. 2 Steinberg et al 48 showed significant differences in QMH measurement upon externally increased pressure of the superficial and deep posterior and anterior compartment. In 2011, Steinberg et al showed that QMH could predict an ICP >45 mm Hg in the anterior tibial compartment with 97% sensitivity and 74% specificity.…”

“…Diagnostic ICP criteria are based on generally weak studies. 2 , 51 Criteria suggested by Pedowitz et al, 33 Puranen and Alavaikko, 36 Styf and Körner, 49 or Aweid et al 3 still lack validity. Their use harbors the risk of a false diagnosis.…”

Non-invasive assessment of muscle compartment elasticity by pressure-related ultrasound in pediatric trauma: a prospective clinical study in 25 cases of forearm shaft fractures

“…Recently, Anwander et al investigated the reliability of a dual sensor approach in healthy volunteers [ 23 ]. Based on the methodology of PrUS, they demonstrated a significant and reliable approach to detect changes of a compression ratio (corresponding to RE) in 60 cases.…”