Endoscopic Compartment Release for Chronic Exertional Compartment Syndrome

Abstract

Exertional compartment syndrome of the leg is a condition that can cause chronic debilitating pain in active persons during a variety of aerobic activities. Nonoperative treatments using stretching protocols and activity modifications are often unsuccessful, and thus several operative strategies have been used to treat this condition. A novel technique for endoscopically assisted fasciotomy for chronic exertional compartment syndrome is described. By use of a small laterally based incision and an arthroscope, polydioxanone sutures are passed percutaneously along the anterior and lateral compartments with the Spectrum suture-shuttling device (ConMed Linvatec, Largo, FL). These sutures are used to retract the skin and subcutaneous tissues over the respective compartments. This method allows excellent visualization of the intercompartmental septum, the superficial peroneal nerve, and all perforating vessels. The anterior and lateral compartments can be safely and completely released with this minimally invasive approach. The patient is allowed to return to full activity at 6 weeks postoperatively, because of the decreased soft-tissue disruption.

Endoscopic Fasciotomy of the Superficial and Deep Posterior Compartments of the Leg

“…[1][2][3] This occurs when tissue pressures within an osteofascial envelope increase during exercise. The intracompartmental pressures become supraphysiologic and result in decreased perfusion, leading to ischemic-type symptoms of lower leg pain.…”

“…10 Endoscopic fasciotomy of the anterior and lateral compartments of the leg has been proven to be safe and effective treatment options of CECS. [1][2][3]5,7,9,10 Endoscopically assisted deep posterior compartment release via an incision 1 to 3 cm behind the medial tibial border cannot improve the outcome, as shown in both cadaveric and clinical studies. [10][11][12] Through this approach, the great saphenous and perforating veins and the saphenous nerve are at risk even under endoscopic visualization.…”

“…The intracompartmental pressures become supraphysiologic and result in decreased perfusion, leading to ischemic-type symptoms of lower leg pain. 2,3 Nonoperative treatments of CECS using stretching protocols and activity modifications are often unsuccessful. 4 Fasciotomy of the involved compartment is the treatment of choice.…”

“…Visualization is superior to minimally invasive blind procedures, especially using a broad speculum that was not traumatic to the subcutaneous veins and nerves. 2,11 Theoretically, optimal visualization with endoscopically assisted fasciotomy may improve clinical outcome through (1) reliable compartment decompression, (2) identification of fascial defects, (3) decompression of nerve branches at the fascial foramen, and (4) reduction of iatrogenic risk to neurovascular and muscular structures. 10 Endoscopic fasciotomy of the anterior and lateral compartments of the leg has been proven to be safe and effective treatment options of CECS.…”

“…Thus, failure to totally release the fascia of the afflicted compartment(s), leading to injury to neurovascular structures and muscle, can result. 1,5 To improve visualization during subcutaneous fasciotomy, different techniques of endoscopic treatment of recalcitrant CECS of the [1][2][3]5,7,9,10 The principal advantages of an endoscopic procedure are smaller incisions, decreased postoperative scarring, and decreased wound healing problems. Visualization is superior to minimally invasive blind procedures, especially using a broad speculum that was not traumatic to the subcutaneous veins and nerves.…”