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

Abstract

BackgroundChronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity.MethodsThe study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded.ResultsThe median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded.ConclusionsMinimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term.

Historic cohort: outcome of chronic exertional compartment syndrome-suspected patients

“…Patients with CECS who had a fasciotomy were satisfied with the surgical therapy and reported better subjective injury status than conservative-treated patients with ERLP. A success rate of 84.4% for fasciotomy in CECS was reported and is in concordance within the range of 78%–98% reported by other studies 3 7 18–20. The difference between fasciotomy and conservative groups in satisfaction rates could be attributed to the near-instant relief of the fasciotomy while conservative-treated patients had to be treated longer for noticeable results.…”

“…A relative high number of deep posterior compartment cases responded to our survey (14/38, 36.8% vs 30/110, 27.3% in our total population). This might suggest that the overall success rate of fasciotomy in our hospital is underestimated, compared with other studies with primary focus on the anterior compartment 3 7 18–20…”

“…In civilian populations the definitive treatment of choice is fasciotomy, with reported success rates of 78%–98% for release of the anterior compartment. In some studies, elite athletes are able to return to former levels of performance in most cases and sometimes beyond that level 3 7 18–20. Release of the deep posterior compartment through fasciotomy has lower success rates, ranging from 50% to 65% 3 7 21.…”

Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

“…One study reported an up to 35 % lat-CECS rate [2]. It is therefore somewhat strange why published results on surgery for this supposedly frequent type of lower leg CECS are scarce [11,13,14,16]. To date, the outcome of isolated CECS of the lateral compartment is reported in just 3 individuals, one with an excellent and 2 with a fair postoperative result [13].…”

“…The presence of untreated CECS is often very incapacitating for active individuals and negatively affects quality of life [11,14]. Up to 85 % of CECS patients are unable to practice sports activities at the desired level before surgery [11,21]. The aim of the operation is to facilitate a return to a desired level of sports activity, but success is not always achieved.…”