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Annals of Biomedical Engineering

, Volume 22, Issue 3, pp 272–279 | Cite as

Mechanical and biochemical analyses of tibial compartment fascia in chronic compartment syndrome

  • Christof Hurschler
  • Ray VanderbyJr.
  • Daniel A. Martinez
  • Arthur C. Vailas
  • William D. Turnipseed
Article

Abstract

Increases in compartment pressure associated with chronic compartment syndrome (CCS) may be due to changes in the mechanical properties and/or thickness of fascia (4,22). To explore this possibility, we compared the mechanical and biochemical characteristics (stiffness, thickness, time-dependent response, collagen content, and collagen crosslinking) of fascia from patients with symptomatic anterior compartment syndrome to fascia from adjacent collateral compartments. We tested 43 specimens harvested from 20 individuals during surgical fasciectomy. Properties of normal (lateral)-compartment (NC) and pathological (anterior)-compartment (PC) fascia were mechanically tested in the axial and transverse directions forming four groups. An external control group (EX) of six specimens of anterior and lateral-compartment fascia harvested from amputated legs was also included in the study. PC fascia was found to be thicker and structurally stiffer (elastic modulus times thickness) in the axial direction than was NC fascia (p≤0.05). No significant differences were found between NC and PC time-dependent response, although significant differences between percent relaxation in the pooled axial and transverse direction specimens were observed. No differences were found in the collagen content, as measured by hydroxyproline (Hyp) concentration, between NC and PC fascia. PC fascia was found to have less collagen crosslinking by hydroxylyslpyridinoline (HP) concentration. In conclusion, although this study does not elucidate etiological factors in CCS, the changes found in PC fascia suggest that fascial mechanical properties contribute to the pathology.

Keywords

Chronic compartment syndrome Fascia Elasticity Viscoelasticity Collagen Collagen crosslinking 

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References

  1. 1.
    Bouché, R.T. Chronic compartment syndrome of the leg. J. Am. Podiatr. Med. Assoc. 80(12):633–648; 1990.PubMedGoogle Scholar
  2. 2.
    Brinkley-Parsons, D.; Glimcher, M.J.; Smith, R.J.; Albin, R.; Adams, J.P. Biochemical changes in the collagen of the palmar fascia in patients with Dupuytren's disease. J. Bone Joint. Surg. 63A(5):787–797; 1981.Google Scholar
  3. 3.
    Butler, D.L.; Grood, E.S.; Noyes, F.R.; Zernicke, R.F.; Bracket, K. Effects of structure and strain measurement technique on the material properties of young human tendons and fascia. J. Biomech. 17(8):579–596; 1984.CrossRefPubMedGoogle Scholar
  4. 4.
    Detmer, D.E.; Sharpe, K.; Sufit, R.L.; Girdley, F.M. Chronic compartment syndrome: diagnosis, management and outcomes. Am. J. Sports Med. 13(3):162–170; 1985.PubMedGoogle Scholar
  5. 5.
    Dunphy, M.J.; Bhide, M.V.; Smith, D.J., Determination of hydroxyproline in tissue collagen hydrolyzate by derivatization and isocratic reverse-phase high-performance liquid chromatography. J. Chromatogr. 420:394–397; 1987.PubMedGoogle Scholar
  6. 6.
    Eyre, D.R.; Paz, M.A.; Gallop, P.M. Cross-linking in collagen and elastin. Annu. Rev. Biochem. 58:717–748; 1984.Google Scholar
  7. 7.
    Eyre, D.R. Collagen cross-linking amino acids. Methods Enzymol. 144:115–139; 1987.PubMedGoogle Scholar
  8. 8.
    Eyre, D.R.; Koob, T.J.; Van Ness, K.P. Quantitation of hydroxypyridinium cross-links in collagen by high-performance liquid chromatography. Ann. Biochem. 137: 380–388; 1984.CrossRefGoogle Scholar
  9. 9.
    Fung, Y.C. Mechanical properties of living tissues. New York: Springer-Verlag; 1981: ch. 7.Google Scholar
  10. 10.
    Garfin, S.R.; Tipton, C.M.; Mubarak, S.J.; Woo, S.L.-Y.; Hargens, A.R.; Akeson, W.H. Role of fascia in maintenance of muscle tension and pressure. J. Appl. Physiol. 51(2):317–320; 1981.PubMedGoogle Scholar
  11. 11.
    Gratz, C.M. Tensile strength and elasticity tests on human fascia lata. J. Bone Joint Surg. 13:334–340; 1931.Google Scholar
  12. 12.
    Jones, W.G.; 2nd; Perry, M.O.; Bush, H.L., Jr. Changes in tibial venous blood flow in the evolving compartment syndrome. Arch. Surg. 124(7):801–804; 1989.PubMedGoogle Scholar
  13. 13.
    Kastelic, J.; Baer, E. Deformation in tendon collagen. Symp. Soc. Exp. Biol. 34:397–435; 1980.PubMedGoogle Scholar
  14. 14.
    Lam, T.C.; Thomas, C.G.; Shrive, N.G.; Frank, C.B.; Sabiston, C.P. The effects of temperature on viscoelastic properties of the rabbit medial collateral ligament. J. Biomech. Eng. 112:147–152; 1990.PubMedGoogle Scholar
  15. 15.
    Matsen, F.A. Compartmental syndromes. New York: Grune and Stratton; 1980; pp. 65–77.Google Scholar
  16. 16.
    Matsen, F.A., III. Compartmental syndrome: A unified concept. Clin. Orthop. 113:8–14; 1975.PubMedGoogle Scholar
  17. 17.
    Mubarak, S.J.; Hargens, A.R. Compartment syndromes and Volkmann's contracture. Philadelphia: W.B. Saunders; 1981.Google Scholar
  18. 18.
    Murrell, G.A.C. The role of the fibroblast in Dupuytren's contracture. Hand Clin. 7(4):669–680; 1991.PubMedGoogle Scholar
  19. 19.
    Myers, B.S.; McElhaney, J.H.; Doherty, B.J. The viscoelastic responses of the human cervical spine in torsion: Experimental limitations of quasi-linear theory, and a method for reducing these effects. J. Biomech. 24(9):811–817; 1991.CrossRefPubMedGoogle Scholar
  20. 20.
    Noyes, F.R.; Butler, D.L.; Grood, E.S.; Zernicke, R.F.; Hefzy, M.S. Biomechanical analysis of human ligament grafts used in knee ligament repairs and reconstructions. J. Bone Joint Surg. 66(3):334–352; 1984.Google Scholar
  21. 21.
    Sauren, A.A.H.; Van Hout, M.C; Van Steenhoven, A.A.; Veldpaus, F.E.; Janssen, J.D. The mechanical properties of porcine aortic valve tissues. J. Biomech. 16(5):327–337; 1983.CrossRefPubMedGoogle Scholar
  22. 22.
    Soffer, S.R.; Martin, D.F.; Stanish, W.D.; Michael, R.H. Chronic compartment syndrome caused by aberrant fascia in an aerobic walker. Med. Sci. Sports Exerc. 23(3):304–306; 1991.PubMedGoogle Scholar
  23. 23.
    Turnipseed, W.; Detmer, D.E.; Gridley, F. Chronic compartment syndrome: An unusual cause for claudication. Ann. Surg. 210(4):557–563; 1989.PubMedGoogle Scholar
  24. 24.
    Vanderby, R., Jr., Masters, G.P.; Bowers, J.R.; Graf, B.K. A device to measure the cross-sectional area of soft connective tissues. IEEE Trans. Biomed. Eng. 38:1040–1042; 1991.CrossRefPubMedGoogle Scholar
  25. 25.
    Woo, S.L.-Y.; Gomez, M.A.; Akeson, W.H. The time and history-dependent viscoelastic properties of the canine medial collateral ligament. J. Biomech. Eng. 103:293–298; 1981.PubMedGoogle Scholar
  26. 26.
    Woo, S.L-Y. Mechanical properties of tendons and ligaments. Biorheology 19:385–396; 1982.PubMedGoogle Scholar
  27. 27.
    Wright, D.G.; Rennels, D.C. A study of the elastic properties of plantar fascia. J. Bone Joint Surg. 46-A(3):482–492; 1964.Google Scholar
  28. 28.
    Yamada, H. Strength of biological materials. Baltimore: Williams & Wilkins; 1970: pp. 297.Google Scholar

Copyright information

© Biomedical Engineering Society 1994

Authors and Affiliations

  • Christof Hurschler
    • 1
  • Ray VanderbyJr.
    • 1
  • Daniel A. Martinez
    • 2
  • Arthur C. Vailas
    • 1
  • William D. Turnipseed
    • 1
  1. 1.Department of SurgeryG5/361 Clinical Science CenterMadison
  2. 2.Department of KinesiologyUniversity of WisconsinMadison

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