Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg

Abstract

Chronic exertional compartment syndrome (CECS) of the leg is a pathological condition often related to overuse in subject who engage repetitive physical activities. Fascial release is the mainstay of surgical management. The purpose of this study was to evaluate the results obtained with a double incision decompressive fasciotomy. Eighteen consecutive athletes with a diagnosis of anterior and/or lateral CECS of the leg were operated on with a minimal double incision fascial release after a mean period of 4 months after onset of symptoms. In 11 cases (61%) CECS was bilateral. Surgery was performed without tourniquet and active mobilization was starting immediately. Sports activities were resumed gradually at a mean period of 25 days. The athletes were followed until 2 years. All resumed pre‐injury level sports activity. Two patients (18%) of the 11 who underwent to bilateral fasciotomy referred a sensation of leg weakness for an average period of 3 months. The surgical technique presented in this paper seems to be a good mean to treat anterior and lateral leg CECS. The use of tourniquet is deconselled to obtain an accurate intraoperative haemostasis so reducing the risk of post‐operative haematoma.

A technique for arthroscopic fasciotomy for the chronic exertional tibialis anterior compartment syndrome

“…Mouhsine et al [14] applied minimal open double incision fasciotomy technique with an anterior and lateral CECS of the leg, and reported good results in 100%.…”

Compartment Syndromes of Thigh and Lower Leg

“…Only the affected compartment(s) should be released. Anterior and lateral fasciotomies have the best outcome (80-90 % success rate), and deep posterior fasciotomies have a lower success rate (50 %) (Brennan and Kane 2003;Hutchinson et al 2003;Mouhsine et al 2006;Tucker 2010). The deep posterior compartment has a more complicated anatomy, and exercise-related lower leg pain can also be related at the same time to traction-induced periostitis or symptomatic traction-induced periosteal remodeling (Stickley et al 2009).…”

“…17, 18, and 19) (Biedert and Marti 1997;Blackman 2000). A higher risk of increased complications and symptom recurrence is reported with the subcutaneous method (Hutchinson et al 2003;de Fijter et al 2006;Mouhsine et al 2006;Tucker 2010). Incomplete fascial release, nerve injuries, and muscle herniation can be responsible for unsuccessful subcutaneous fasciotomy and lead to complications and inferior outcome (Leversedge et al 2002).…”

Compartment Syndrome of the Lower Leg and Foot

“…Although the chronic exertional compartment syndrome is not an acute injury, surgical release is the treatment of choice [89]. In contrast to trauma-associated compartment syndrome, minimally invasive approaches were used at the lower leg with excellent results [18,61].…”