The natural course of chronic exertional compartment syndrome of the lower leg

Wal, Wybren A. van der; Heesterbeek, Petra J.C.; Brand, Johan G. H. van den; Verleisdonk, E. J. M. M.

doi:10.1007/s00167-014-2847-2

Cited by 20 publications

(15 citation statements)

References 28 publications

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“…Improvement of symptoms or satisfaction was reported by 47% (±42%) of the patients who completed a follow-up analysis, whereas 50% (±45%) returned to a form of physical activity. The well-structured gait retraining programs 20,23 and treatment with botulinum injections 22 scored highest with satisfaction rates ranging from 89% to 100%, whereas all studies with patients alone initiated modifications in activity and/or lifestyle 7,8,[24][25][26][27] scored between 0% and 84% satisfaction. Among the 171 conservatively treated patients, six cases were reported to eventually opt for surgery.…”

Section: Outcome Following Conservative Treatmentmentioning

confidence: 99%

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Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Vogels

Ritchie

Dongen

et al. 2020

Scandinavian Med Sci Sports

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Objective Surgery is the gold standard in the management of chronic exertional compartment syndrome (CECS) of the lower extremity, although recent studies also reported success following gait retraining. Outcome parameters are diverse, and reporting is not standardized. The aim of this systematic review was to analyze the current evidence regarding treatment outcome of CECS in the lower leg. Material and Methods A literature search and systematic analysis were performed according to the PRISMA criteria. Studies reporting on outcome following treatment of lower leg CECS were included. Results A total of 68 reports fulfilled study criteria (n =; 3783; age range 12‐70 year; 7:4 male‐to‐female ratio). Conservative interventions such as gait retraining (n =; 2) and botulinum injection (n =; 1) decreased ICP (truex- =; 68 mm Hg totruex- =; 32 mm Hg) and resulted in a 47% (±42%) rate of satisfaction and a 50% (±45%) rate of return to physical activity. Fasciotomy significantly decreased ICP (truex- =; 76 mm Hg to truex- =; 24 mm Hg) and was associated with an 85% (±13%) rate of satisfaction and an 80% (±17%) rate of return to activity. Return to activity was significantly more often achieved (P < .01) in surgically treated patients, except in one study favoring gait retraining in army personnel. Conclusion Surgical treatment of CECS in the lower leg results in higher rates of satisfaction and return to activity, compared to conservative treatment. However, the number of studies is limited and the level of evidence is low. Randomized controlled trials with multiple treatment arms and standardized outcome parameters are needed.

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Section: Outcome Following Conservative Treatmentmentioning

confidence: 99%

“…ICP values were obtained both before and after surgical intervention in nine of thirty studies. Five 7,8,[28][29][30] of these found a statistically significant reduction of ICP, suggesting that surgical intervention is effective in reducing muscle compartment pressures.…”

Section: Outcome Following Surgical Treatmentmentioning

confidence: 99%

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Vogels

Ritchie

Dongen

et al. 2020

Scandinavian Med Sci Sports

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“…This cohort study compares treatment outcome as reflected by changes in cardinal symptoms, patient satisfaction, as well as return to physical activity. Similar differences in satisfaction favoring surgery were already demonstrated in most small cohorts [6,8,22,23]. However, an exact description of the methodology for determining satisfaction was often lacking.…”

Section: Discussionmentioning

confidence: 61%

Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

et al. 2020

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The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.

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“…However, a recent study showed that there is a negligible correlation between intracompartmental pressure and exertional pain experienced in the leg 1. CECS is mainly described in active athletes and military recruits, both dealing with sudden increases in the amount or intensity of activity 2–6…”

Section: Introductionmentioning

confidence: 99%

“…Without proper treatment, symptoms of CECS have shown to persist over time in a military population as long as 50 months 4. In civilian populations the definitive treatment of choice is fasciotomy, with reported success rates of 78%–98% for release of the anterior compartment.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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IntroductionExercise-related leg pain (ERLP) may be caused by chronic exertional compartment syndrome (CECS), occurring mainly in athletes and military recruits. In military populations, the effectiveness of surgical treatment in CECS is debated. The purpose of this study is to assess the outcome of surgical treatment for CECS in Alrijne Hospital (the Netherlands), a civilian hospital with supraregional referral function.MethodsA historic cohort study was performed on patients with ERLP who were suspected for CECS and were referred for intracompartmental pressure measurement (ICPM) from 2013 to 2017 (n=160). Patient demographics, ICPM and survey response were analysed.ResultsThe mean delay before visitation was 29.0±30.3 months. When comparing surgical-treated patients with CECS with conservative-treated patients with ERLP, surgical-treated patients were more satisfied, reported better recovery towards former level of performance (2.8±2.0 vs 3.9±1.7 and 2.5±1.6 vs 3.2±1.4 on a 7-point Likert scale, respectively) and better subjective injury status (79.3±22.6 vs 63.5±27.4 using the Single Assessment Numeric Evaluation score). Treatment satisfaction was 75.0% in surgical-treated CECS versus 51.4% in conservative-treated ERLP.ConclusionCivilian patients report improved functional outcomes after fasciotomy for CECS. Future research should focus on non-invasive diagnostic options and methods to determine which treatment is the most appropriate for each individual patient.

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The natural course of chronic exertional compartment syndrome of the lower leg

Abstract: Case series with no comparative group, Level IV.

Cited by 20 publications

References 28 publications

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg

Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

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

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