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Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort

  • Original Article • LOWER LIMB - SPORT
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Chronic exertional compartment syndrome (CECS) is an overuse disorder typically affecting an athletic population. CECS is a diagnosis based on history and intracompartmental pressure (ICP) testing. CECS patients can be treated surgically by fasciotomy; however, research on the relationship between ICP and patient symptoms and also between ICP and patient-reported outcome post-fasciotomy is limited. This study aims to (1) assess functional outcome and patient satisfaction post-fasciotomy and (2) identify any potential correlation between ICP and reported levels of pain.

Methods

138 CECS patients who had ICP measurements and subsequently underwent fasciotomy were identified from our regional service for exercise-induced lower limb extremity pain between January 2000 and March 2017. Clinical outcomes were recorded at the time of ICP testing and in the post-operative follow-up clinic. Pain was reported using a verbal rating scale (VRS) (‘low’, ‘moderate’ or ‘high’) or as a visual analogue score (VAS) 0–10 (0 = least painful, 10 = most painful). Spearman’s ranked correlation test was used to calculate correlation between ICP and reported pain.

Results

A total of 138 patients were eligible for inclusion in this study (mean age 29.7 ± 9.7 years, 110 M, 28 F) of which 109 patients (VRS n = 61, VAS n = 48) reported pain level at pre- and post-operative stages. Mean pre-operative VAS score was 8.52 ± 0.71, and decreased to 0.77 ± 0.69 post-operatively. An insignificant positive correlation (r = 0.046, two-tailed p = 0.76) was found between VAS pain and ICP. A significant moderate positive correlation (r = 0.497, two-tailed p = 0.01) was found between VRS pain and ICP.

Conclusion

Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.

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References

  1. McLaughlin N, Heard H, Kelham S (2014) Acute and chronic compartment syndromes: know when to act fast. J Am Acad Phys Assist 27(6):23–26

    Google Scholar 

  2. Blackman PG (2000) A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc 32(3 Suppl):S4–S10

    CAS  PubMed  Google Scholar 

  3. Brewer RB, Gregory AJ (2012) Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health 4(2):121–127

    Article  PubMed  PubMed Central  Google Scholar 

  4. Davis DE, Raikin S, Garras DN, Vitanzo P, Labrador H, Espandar R (2013) Characteristics of patients with chronic exertional compartment syndrome. Foot Ankle Int 34(10):1349–1354

    Article  PubMed  Google Scholar 

  5. Paik RS, Pepples D, Hutchinson MR (2013) Chronic exertional compartment syndrome. BMJ 346(7896):35–37

    Google Scholar 

  6. Dunn JC, Waterman BR (2014) Chronic exertional compartment syndrome of the leg in the military. Clin Sports Med 33(4):693–705

    Article  PubMed  Google Scholar 

  7. Murdock M, Murdoch MM (2012) Compartment syndrome: a review of the literature. Clin Podiatr Med Surg 29(2):301–310

    Article  PubMed  Google Scholar 

  8. Van der Wal WA, Heesterbeek PJ, Van den Brand JG, Verleisdonk EJ (2015) The natural course of chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc 23(7):2136–2141

    Article  PubMed  Google Scholar 

  9. Styf JR, Korner LM (1987) Diagnosis of chronic anterior compartment syndrome in the lower leg. Acta Orthop Scand 58:139–144

    Article  CAS  PubMed  Google Scholar 

  10. Van den Brand JG, Verleisdonk EJ (2004) Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome. Am J Sports Med 32:452–456

    Article  PubMed  Google Scholar 

  11. Verleisdonk EJ, van Gils A, van der Werken C (2001) The diagnositc value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg. Skeletal Radiol 30:321–325

    Article  CAS  PubMed  Google Scholar 

  12. Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH (1990) Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 18(1):35–40

    Article  CAS  PubMed  Google Scholar 

  13. Tiidus PM (2014) Is intramuscular pressure a valid diagnostic criterion for chronic exertional compartment syndrome? Clin J Sport Med 24(1):87–88

    Article  PubMed  Google Scholar 

  14. Roscoe D, Roberts AJ, Hulse D (2015) Intramuscular compartment pressure measurement in chronic exertional compartment syndrome: new and improved diagnostic criteria. Am J Sports Med 43(2):392–398

    Article  PubMed  Google Scholar 

  15. Stubhaug A, Breivik H (2016) Chronic compartment syndrome is an under-recognized cause of leg-pain. Scand J Pain 1(12):53–54

    Article  Google Scholar 

  16. Gilmour H (2015) Chronic pain, activity restriction and flourishing mental health. Health Rep 26(1):15

    PubMed  Google Scholar 

  17. Gatzounis R, Schrooten MG, Crombez G, Vlaeyen JW (2014) Interrupted by pain: an anatomy of pain-contingent activity interruptions. Pain 155(7):1192–1195

    Article  PubMed  Google Scholar 

  18. Orlin JR, Lied IH, Stranden E, Irgens HU, Andersen JR (2016) Prevalence of chronic compartment syndrome of the legs: implications for clinical diagnostic criteria and therapy. Scand J Pain 31(12):7–12

    Article  Google Scholar 

  19. Beck JJ, Tepolt FA, Miller PE, Micheli LJ, Kocher MS (2016) Surgical treatment of chronic exertional compartment syndrome in pediatric patients. Am J Sports Med 44(10):2644–2650

    Article  PubMed  Google Scholar 

  20. Winkes MB, van Zantvoort AP, de Bruijn JA, Smeets SJ, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Scheltinga MR (2016) Fasciotomy for deep posterior compartment syndrome in the lower leg a prospective study. Am J Sports Med 44(5):1309–1316

    Article  PubMed  Google Scholar 

  21. Pasic N, Bryant D, Willits K, Whitehead D (2015) Assessing outcomes in individuals undergoing fasciotomy for chronic exertional compartment syndrome of the leg. Arthroscopy 31(4):707–713

    Article  PubMed  Google Scholar 

  22. Roberts AJ, Krishnasamy P, Quayle JM, Houghton JM (2014) Outcomes of surgery for chronic exertional compartment syndrome in a military population. J R Army Med Corps. Mar 31:jramc-2013

  23. McCallum JR, Cook JB, Hines AC, Shaha JS, Jex JW, Orchowski JR (2014) Return to duty after elective fasciotomy for chronic exertional compartment syndrome. Foot Ankle Int 35(9):871–875

    Article  PubMed  Google Scholar 

  24. Packer JD, Day MS, Nguyen JT et al (2013) Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. Am J Sports Med 41:430

    Article  PubMed  Google Scholar 

  25. Slimmon D, Bennell K, Brukner P, Crossley K, Bell SN (2002) Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg. Am J Sports Med 30(4):581–588

    Article  PubMed  Google Scholar 

  26. Brennan F, Kane S (2003) Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome. Curr Sport Med Rep. 2:247–250

    Article  Google Scholar 

  27. Cook S, Bruce G (2002) Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg 72(10):720–723

    Article  PubMed  Google Scholar 

  28. Verleisdonk E, Schmitz R, Werken C (2004) Long term results of fasciotomy of the anterior compartment in patients with exercise-induced pain in the lower leg. Int J Sports Med 25(3):224–229

    Article  CAS  PubMed  Google Scholar 

  29. Roberts AJ, Krishnasamy P, Quayle JM, Houghton JM (2015) Outcomes of surgery for chronic exertional compartment syndrome in a military population. J R Army Med Corps 161:42–45

    Article  PubMed  Google Scholar 

  30. Baumgarten KM (2013) Chronic exertional compartment syndrome: are surgical outcomes worse in soldiers compared with civilians. J Bone Joint Surg Am 95:e481–e482

    Article  Google Scholar 

  31. Shah S, Miller B, Kuhn J (2004) Chronic exertional compartment syndrome. Am J Orthop 33(7):335–341

    PubMed  Google Scholar 

  32. Trease L, Every B, Bennell K et al (2001) A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg. Eur J Nucl Med 28(6):688–695

    Article  CAS  PubMed  Google Scholar 

  33. Jensen MP, Tomé-Pires C, de la Vega R, Galán S, Solé E, Miró J (2017) What determines whether a pain is rated as mild, moderate, or severe? The importance of pain beliefs and pain interference. Clin J Pain 33(5):414–421

    Article  PubMed  PubMed Central  Google Scholar 

  34. Nauck T, Lohrer H, Padhiar N, King JB (2015) Development and validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain. Br J Sports Med 49(2):113–117

    Article  PubMed  Google Scholar 

  35. Schubert AG (2011) Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release. Int J Sports Phys Ther 6(2):126

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK

    J. P. H. Tam

  2. Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK

    A. G. F. Gibson, J. R. D. Murray & M Hassaballa

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  1. J. P. H. Tam
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  2. A. G. F. Gibson
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  3. J. R. D. Murray
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  4. M Hassaballa
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Correspondence to J. P. H. Tam.

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Conflict of interest

Dr JPH Tam, Mr AGF Gibson, Mr JRD Murray and Dr M Hassaballa declare that they have no conflict of interest.

Additional information

A. G. F. Gibson: Retired from Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.

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Tam, J.P.H., Gibson, A.G.F., Murray, J.R.D. et al. Fasciotomy for chronic exertional compartment syndrome of the leg: clinical outcome in a large retrospective cohort. Eur J Orthop Surg Traumatol 29, 479–485 (2019). https://doi.org/10.1007/s00590-018-2299-3

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  • DOI: https://doi.org/10.1007/s00590-018-2299-3

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