Two-Compartment or 4-Compartment Fasciotomy for Lower Leg Chronic Exertional Compartment Syndrome: A Systematic Review

Weiss, Chris; Vogels, Sanne; Wee, Leonard; Janssen, Loes; Bie, Rob A. de; Scheltinga, Marc R.

doi:10.1053/j.jfas.2022.02.011

Cited by 8 publications

(2 citation statements)

References 35 publications

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“…The anterior and lateral compartments were the most commonly released compartments, with the superficial and deep posterior compartments less commonly released. Weiss et al 19 in a systematic review reported similar rates of fasciotomy techniques in the literature, with no return to activity or patient satisfaction differences between groups.…”

Section: Discussionmentioning

confidence: 91%

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

Shankar

Avendano

et al. 2023

Clinical Journal of Sport Medicine

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Objective: To determine whether concomitant psychiatric diagnoses and medication use were associated with postfasciotomy outcomes in patients with chronic exertional compartment syndrome (CECS). Design: Retrospective comparative cohort study. Setting: Single academic medical center from 2010 to 2020. Patients: All patients above 18 years old who underwent fasciotomy for CECS. Assessment of Risk Factors/Independent Variables: Psychiatric history was recorded from electronic health records including disease diagnosis and medications. Main Outcome Measures: The 3 main outcome measures were postoperative pain using the Visual Analog Scale, functional outcomes using the Tegner Activity Scale, and return to sport. Results: Eighty one subjects (legs), 54% male, with an average age of 30 years and follow-up of 52 months were included. 24 subjects (30%) had at least one psychiatric diagnosis at the time of surgery. Regression analysis found psychiatric history to be an independent predictor of worse postoperative pain severity and postoperative Tegner scores (P , 0.05). Furthermore, subjects with psychiatric disorders not on medication had worse pain severity (P , 0.001) and Tegner scores (P , 0.01) versus controls, whereas subjects with a psychiatric disorder on medication had better pain severity (P , 0.05) versus controls. Conclusions: History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS. Use of psychiatric medication was associated with improvement in pain severity in some domains.

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Section: Discussionmentioning

confidence: 91%

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

Shankar

Avendano

et al. 2023

Clinical Journal of Sport Medicine

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“…Overall, 78.1% of patients were satisfied with their procedure. Weiss et al (36) investigated whether performing a two-compartment versus four-compartment fasciotomy proved more successful. However, there were no statistical differences between patient satisfaction, presence of residual symptoms, or return to activity rate.…”

Section: Surgerymentioning

confidence: 99%

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

Malik

Vyas

2023

Curr Sports Med Rep

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Chronic exertional compartment syndrome is a condition that typically affects athletic/active individuals. Chronic exertional compartment syndrome predominantly affects the lower leg; however, there are cases involving the hand, forearm, foot, and thigh. The signs and symptoms of chronic exertional compartment syndrome are severe pain, tightness, cramping, muscle weakness, and paresthesias during participation in exercise. Dynamic intramuscular compartmental pressure (preexertion and postexertion) is the standard diagnostic test. Although other imaging modalities, such as radiography, ultrasound, and magnetic resonance imaging are typically incorporated to rule out other pathologies. In addition, these modalities are being utilized to limit invasiveness of the diagnostic experience. Initial care commonly involves conservative treatment, such as physical therapy, modifications of patient's exercise technique, foot orthoses, and various procedures over a period of 3 to 6 months. Recalcitrant cases may be referred for surgical intervention (fasciotomy), which has inconclusive head-to-head data with conservative management with regard to return to prior sport and specific activity level.

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Female patients have greater improvement in pain symptoms and physical activity after fasciotomy for treatment of chronic exertional compartment syndrome of the lower leg

Shankar,

Vasavada,

Gillinov

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to identify sex differences in postoperative outcomes and return‐to‐sport rates after fasciotomy for treatment of chronic exertional compartment syndrome (CECS) of the lower leg. It was hypothesised that male CECS patients would have a higher rate of return to sport than female CECS patients.MethodsA retrospective cohort study was conducted involving patients who underwent primary fasciotomy of one to four leg compartments for treatment of CECS at a single centre from 2010 to 2020. Each affected leg was treated as a separate subject. Postoperative outcomes included CECS pain frequency and severity, return to sport and Tegner activity level. Multivariable regression was used to determine if sex was an independent predictor of outcomes after adjusting for demographic and clinical covariates. p < 0.05 were considered significant.ResultsEighty‐one legs (44 M, 37 F) of 47 unique patients (34 of whom had bilateral symptoms) were included with a mean follow‐up time of 51.5 ± 31.4 months. Male subjects were older (p < 0.001) and had higher body mass index (p < 0.001) compared to female subjects. Most subjects (84.0%) underwent two‐ or four‐compartment fasciotomies. Female sex was found to be predictive of lower overall postoperative pain severity (p = 0.007), higher odds of return to sport (p = 0.04) and higher postoperative Tegner score (p = 0.005). However, female sex was not predictive of postoperative pain frequency, odds of reoperation or odds of return to sport to at least the presymptomatic level (all p < 0.05).ConclusionFemale sex is independently predictive of reduced overall pain severity, higher odds of return to sport and higher postoperative improvement in Tegner score following fasciotomy for treatment of lower‐limb CECS.Level of EvidenceIII.

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Two-Compartment or 4-Compartment Fasciotomy for Lower Leg Chronic Exertional Compartment Syndrome: A Systematic Review

Cited by 8 publications

References 35 publications

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

Psychiatric Disorders Are Predictive of Worse Pain Severity and Functional Outcomes After Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg

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

Female patients have greater improvement in pain symptoms and physical activity after fasciotomy for treatment of chronic exertional compartment syndrome of the lower leg

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