Functional Outcomes After the Surgical Management of Isolated Anterolateral Leg Chronic Exertional Compartment Syndrome

Abstract

Background:Failure rates of up to 20% have been reported after fasciotomy for chronic exertional compartment syndrome (CECS). There is some evidence that postoperative failure and complication rates are higher in the posterior compartments of the lower leg than the anterolateral compartments. Isolated compartment surgery may put patients at risk of requiring revision surgery because of the risk of developing posterior compartment disease.Hypothesis:Isolated anterolateral fasciotomy for CECS, in the absence of posterior compartment symptoms, produces satisfactory functional outcomes.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2012, patients who had positive intracompartment pressure-testing findings and who underwent isolated anterolateral fasciotomy release for CECS were given a self-administered questionnaire. The minimum follow-up was 3 years. The questionnaire addressed time to return to sport and ongoing symptoms. A visual analog scale was used to assess pain during exercise before and after surgery (score: 0, no pain; 10, worst pain imaginable); overall satisfaction with the procedure was assessed as well. Of 31 eligible patients, 20 patients (36 legs operated on) were assessed.Results:Postoperatively, 90% of participants returned to the same or higher level of sport. The mean pain score during exercise before surgery was 8.17, whereas it was 1.74 after surgery. The overall mean patient satisfaction score was 8.64. Only 1 leg (2.8%) went on to develop posterior compartment syndrome.Conclusion:Isolated anterolateral fasciotomy for CECS produced excellent functional outcomes. Our rate of recurrence was low compared with those found in the literature, and 90% of participants returned to their same or higher level of sport postoperatively.

Outcome following mini-open lower limb fasciotomy for chronic exertional compartment syndrome

“…Although the MLLF technique appears to be effective in reducing pain, most patients reported some degree of leg pain at longer-term follow-up, in keeping with existing studies [6,13,14]. Abnormal sensation complicates up to 62% of fasciotomy procedures [6,8,10,[13][14][15][16][17][18][19][20][21]23], and the reasons for the slightly higher prevalence of sensory abnormalities we observed (67%) are unclear. Notably, only one-quarter of patients described constant sensory symptoms, with forty per cent reporting these only on activity.…”

“…Although non-operative management may be effective in some instances [4], CECS symptoms often persist [5] and lower limb fasciotomy an accepted surgical treatment to facilitate return to activity [6]. Fasciotomy may be performed open [6][7][8][9][10][11][12][13][14][15][16][17][18][19] or using a percutaneous or mini-open approach [20][21][22][23]. There is considerable variation in operative technique and reported outcome.…”

Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

“…Of those who returned, approximately 40% were at their presurgical level, while the remaining 60% were at a lower level of sport. 34 Gatenby et al 8 similarly investigated outcomes after isolated anterolateral compartment release and reported that 90% of patients return to sports at the same or higher level postoperatively. This study similarly notes that patients who required revision surgery were often returning to the operating room to release compartments previously not released.…”

Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

“…12 Patients with high muscle pressure in the anterior or lateral compartment occasionally experience awkward foot sensations in the dermatome of the deep peroneal nerve (web space between first and second toes) or the superficial peroneal nerve (dorsum of foot), respectively. 5 Our patients were asked to indicate areas of altered skin sensation of the foot, if present, on a drawing. Approximately one-third of our patients reported alterations in skin sensation, possibly reflecting compression of either the deep or superficial peroneal nerve.…”

“…It is our experience that some patients with ELP spontaneously report altered foot skin sensation, possibly reflecting compromised leg peripheral nerves in the presence of CECS. 5 A recent study indicated that patient pain drawings may offer a potential instrument contributing to identifying the cause of ELP. 12 Therefore, when patients experienced altered foot skin sensation and/or tingling, they were asked to mark this area on a drawing (Figure 1).…”