Anatomical dissection of the deep posterior compartment and its correlation with clinical reports of chronic compartment syndrome involving the deep posterior compartment

Kwiatkowski, Timothy C.; Detmer, Don E.

doi:10.1002/(sici)1098-2353(1997)10:2<104::aid-ca6>3.0.co;2-v

Cited by 21 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is likely because of their localization under the superficial posterior leg compartment (gastrocnemii and soleus), and because of interactions between contractile and connective tissue elements. For instance, the posterior deep muscle compartment (FDL, FHL and TP) is composed of thin muscles, close to the main posterior neurovascular bundle (posterior tibial vessels and the tibial nerve) (Kwiatkowski & Detmer, 1997;Bianchi & Martinoli, 2007) and underneath the lower limb deep transverse fascia (Benjamin, 2009). Consequently, the US transducer orientation was adjusted in real time to maintain a longitudinal view of the targeted structure during the motion and US images clear of non-muscular structures.…”

Section: Discussionmentioning

confidence: 99%

Stiffness mapping of lower leg muscles during passive dorsiflexion

et al. 2017

View full text Add to dashboard Cite

It is challenging to differentiate the mechanical properties of synergist muscles in vivo. Shear wave elastography can be used to quantify the shear modulus (i.e. an index of stiffness) of a specific muscle. This study assessed the passive behavior of lower leg muscles during passive dorsiflexion performed with the knee fully extended (experiment 1, n = 22) or with the knee flexed at 90° (experiment 2, n = 20). The shear modulus measurements were repeated twice during experiment 1 to assess the inter-day reliability. During both experiments, the shear modulus of the following plantar flexors was randomly measured: gastrocnemii medialis (GM) and lateralis (GL), soleus (SOL), peroneus longus (PL), and the deep muscles flexor digitorum longus (FDL), flexor hallucis longus (FHL), tibialis posterior (TP). Two antagonist muscles tibialis anterior (TA), and extensor digitorum longus (EDL) were also recorded. Measurements were performed in different proximo-distal regions for GM, GL and SOL. Inter-day reliability was adequate for all muscles (coefficient of variation < 15%), except for TP. In experiment 1, GM exhibited the highest shear modulus at 80% of the maximal range of motion (128.5 ± 27.3 kPa) and was followed by GL (67.1 ± 24.1 kPa). In experiment 2, SOL exhibited the highest shear modulus (55.1 ± 18.0 kPa). The highest values of shear modulus were found for the distal locations of both the GM (80% of participants in experiment 1) and the SOL (100% of participants in experiment 2). For both experiments, deep muscles and PL exhibited low levels of stiffness during the stretch in young asymptomatic adults, which was unknown until now. These results provide a deeper understanding of passive mechanical properties and the distribution of stiffness between and within the plantar flexor muscles during stretching between them and thus could be relevant to study the effects of aging, disease progression, and rehabilitation on stiffness.

show abstract

Section: Discussionmentioning

confidence: 99%

Stiffness mapping of lower leg muscles during passive dorsiflexion

et al. 2017

View full text Add to dashboard Cite

show abstract

“…11 Some studies have suggested that the significantly higher failure rate associated with release of the deep posterior compartment may be related to variable anatomic features, whereby some patients possess a “fifth compartment” of the lower leg formed by a fibular attachment of the flexor digitorum longus (FDL) muscle. 9,10,19 This osseofascial sheath has the ability to compress segments of the tibialis posterior muscle (TPM), thereby raising pressures and producing the symptoms of exertional compartment syndrome. Figure 1A demonstrates a cross-sectional view of the lower leg to highlight the relationships between these structures.…”

mentioning

confidence: 99%

Release of the Tibialis Posterior Muscle Osseofascial Sheath Improves Results of Deep Exertional Compartment Syndrome Surgery: A Comparative Analysis and Long-term Results

Bellamy

Boissonneault

Melquist

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Success rates for surgical management of chronic exertional compartment syndrome (CECS) are historically lower with release of the deep posterior compartment compared with isolated anterolateral releases. At our institution, when a deep posterior compartment release is performed, we routinely examine for a separate posterior tibial muscle osseofascial sheath and release it if present. Purpose: Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in patients who underwent 2-compartment fasciotomy versus a modified 4-compartment fasciotomy for CECS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients treated with fasciotomy for lower extremity CECS from 2007 to 2017 were retrospectively identified. In all patients in whom a 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath, which was released when present. Patients completed a series of validated patient-reported outcome (PRO) surveys, including the Marx activity score, Tegner activity score, 12-Item Short Form Health Survey, and Likert score for patient satisfaction. Results: Of the 48 patients who were included in this study, 34 (71%) patients with a total of 52 operative limbs responded and completed PRO surveys. The mean follow-up for the entire cohort was 5.5 ± 2.6 years. Of the 34 patients, 23 (68%) underwent 2-compartment fasciotomy and 11 (32%) underwent 4-compartment fasciotomy. Among the patients in the 4-compartment fasciotomy group, 7 (64%) were found to have a fifth compartment. No significant difference was found in any of the validated PRO measures between patients who had a 2- versus 4-compartment fasciotomy or those who underwent 4-compartment fasciotomy with or without a present fifth compartment. At a mean 5.5-year follow-up, 74% of patients who underwent a 2-compartment release reported good or excellent outcomes compared with 82% of patients who underwent our modified 4-compartment release. Conclusion: The current study, which included the longest follow-up on CECS patients in the literature, demonstrated that the addition of a release of the posterior tibial muscle fascia led to no significant difference in PRO measures between patients who underwent a 2- versus 4-compartment fasciotomy, when historically the 2-compartment fasciotomy group has had higher success rates.

show abstract

“…On the other hand, isolated inferior deep compartment syndrome can result in more localised involvement at the musculotendinous region of the FHL. However, the location of involvement did not match the region of involvement in inferior deep compartment syndrome [10,11].…”

Section: Discussionmentioning

confidence: 94%