Long‐term result of fasciotomy caused by medial tibial syndrome in athletes

Abstract

term result of fasciotomy caused by medial tibial syndrome in athletes. Scand J Med Sci Sports 1991: 1: 59-61.Sixty fasciotomies of the deep posterior compartment were performed on 30 patients with longstanding bilateral medial tibial syndrome (mean duration 25 months). The initial symptoms occurred during sports activities in all cases. Only 2 of the athletes were able to continue sports at an ordinary activity level. The diagnosis was based on a typical history of longstanding exertional pain and clinical findings of tenderness at the postero-medial border of the tibia. Radiographs showed no abnormalities. Scintigrams were performed in 12 patients in whom stress fractures could not be excluded by radiographs and clinical examination. Conservative treatment failed to relieve the symptoms. At follow-up 34 months (range 6-85) after surgery, 95% of the men and 73% of the women were free of symptoms or improved compared with prior to surgery. Whereas 68% of the men were totally free of symptoms, the corresponding figure for the women was 36%. Ninety-five percent of the men and 82% of the women returned to sport after surgery. Seventy-four percent of the men and 54% of the women returned to an activity level similar to that prior to injury. We conclude that fasciotomy of the deep posterior compartment gives a good long-term result in patients with medial tibial syndrome when conservative treatment fails. There was no significant difference between the sexes.The medial tibial syndrome is characterized by a history of refractory pain at the posterior-medial border of the tibia during physical activity, despite periods of rest, use of orthotics and proper rehabilitation (2). In contrast to the anterior compartment syndrome (8), the medial tibial syndrome is not associated with an increase in muscle relaxation pressure, ischaernic pain or impaired muscle function. There is a general agreement on the aetiology and diagnostic criteria for surgical treatment of anterior compartment syndrome, whereas the opinion on the aetiology of the medial tibial syndrome deviates. Despite different opinions on the appearance of increased intramuscular pressure in the deep posterior compartment during and after exercise, authors of both opinions (5,lO) present good results after decompression of the deep posterior compartment in patients with medial tibial syndrome.The purpose of this study was to evaluate the long-term functional results of fasciotomy of the deep posterior compartment in 30 patients with bilateral medial tibial syndrome. Material and methodsThirty subjects, 17 competitive and 13 recreational athletes, participated in the study. There were 19 men with a mean age of 25 years (range 15-36) and 11 women with a mean age of 19 years (range 15-28). They were all operated on with fasciotomy caused by bilateral medial tibial syndrome from 1974 to 1986. The diagnosis was based on a thorough history and clinical findings of tenderness at the postero-medial border of the tibia. The patients correspond to the medial tibial stress syn...

Medial Tibial Stress Syndrome (Tibial Fasciitis)

“…[29][30][31][32][33][34] Although shin splint straps are commonly used in clinical practice, the results of this study suggest that they may be ineffective. When pathology is localized to the medial tibial crest, two therapies have proved beneficial in our experience: therapeutic injections using local anesthetic and acetate steroid (providing an anti-inflammatory effect) and surgical release of the tibial fascia.…”

An experimental in vivo method for analysis of local deformation on tibia, with simultaneous measures of ground reaction forces, lower extremity muscle activity and joint motion

“…Injuries to the tibia were poorly defined and cannot be referred to simply as chronic injury sites. It may also be argued that lower leg pain may be related to various disorders such as skeletal stress reactions of the tibia (2, 6, 23-28), medial tibial stress syndrome (27), chronic deep posterior compartment syndrome (22), shin splints (28) and other injuries.…”

Overuse injuries of the lower extremity in runners

“…Several authors as De Haven et al (73) conclude that nonoperative treatment is successful, also in a majority of patients with patellofemoral syndrome. When conservative treatment fails, surgery can relieve symptoms in some longstanding overuse injuries such as medial tibia1 syndrome (74), anterior stress fractures of tibia (69, 72, 7 9 , adductor longus tendinitis (76) and partial achilles tendon ruptures (77 and references cited herein). Some overuse injuries such as stress fractures of the femoral neck should be treated with caution, since the complications may be severe (78).…”

“…Lower leg pain is common in runners and may be related to skeletal stress reactions or fractures of tibia (5, [70][71][72], medial tibial stress syndrome (74), chronic deep posterior compartment syndrome (102), shin splints (97) or other injuries. Anterior chronic com-partment syndrome (98) is are in runners, associated with increased intramuscular pressure in the anterior tibial muscle relieved by fasciotomy, which can be performed in local anesthesia.…”

“…Shin splints, as discussed by Johnell et al (97), show pain more spread along the medial edge of tibia and are suggested as microstress fractures referring to findings from bone biopsies. The medial tibial stress syndrome is characterized by a history of refractory exertional pain at the posteromedial border of tibia, sometimes responding negatively to periods of rest and proper rehabilitation (74). There is a general Fig.…”