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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2016 | Research article

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

Authors: Nicola Maffulli, Mattia Loppini, Filippo Spiezia, Alessio D’Addona, Gayle D. Maffulli

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2016

Abstract

Background

Chronic 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.

Methods

The 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.

Results

The 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.

Conclusions

Minimally 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.

Allen MJ, Barnes MR. Exercise pain in the lower leg. Chronic compartment syndrome and medial tibial syndrome. J Bone Joint Surg Br. 1986;68:818–23.PubMed

Balduini FC, Shenton DW, O'Connor KH, Heppenstall RB. Chronic exertional compartment syndrome: correlation of compartment pressure and muscle ischemia utilizing 31P-NMR spectroscopy. Clin Sports Med. 1993;12:151–65.PubMed

Detmer DE, Sharpe K, Sufit RL, Girdley FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985;13:162–70.CrossRefPubMed

Qvarfordt P, Christenson JT, Eklof B, Ohlin P, Saltin B. Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome. Clin Orthop Relat Res. 1983;179:284–90.CrossRefPubMed

Styf J, Forssblad P, Lundborg G. Chronic compartment syndrome in the first dorsal interosseous muscle. J Hand Surg Am. 1987;12:757–62.CrossRefPubMed

Styf J, Korner L, Suurkula M. Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome. J Bone Joint Surg Br. 1987;69:301–5.PubMed

Styf J, Lysell E. Chronic compartment syndrome in the erector spinae muscle. Spine (Phila Pa 1976). 1987;12:680–2.CrossRef

Styf JR, Korner LM. Diagnosis of chronic anterior compartment syndrome in the lower leg. Acta Orthop Scand. 1987;58:139–44.CrossRefPubMed

Bell S. Repeat compartment decompression with partial fasciectomy. J Bone Joint Surg Br. 1986;68:815–7.PubMed

10.

Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. 2000;32:S4–10.PubMed

11.

Puranen J, Alavaikko A. Intracompartmental pressure increase on exertion in patients with chronic compartment syndrome in the leg. J Bone Joint Surg Am. 1981;63:1304–9.PubMed

12.

Rorabeck CH, Bourne RB, Fowler PJ. The surgical treatment of exertional compartment syndrome in athletes. J Bone Joint Surg Am. 1983;65:1245–51.PubMed

13.

Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. 1993;21:811–7.CrossRefPubMed

14.

Wallensten R, Eriksson E. Intramuscular pressures in exercise-induced lower leg pain. Int J Sports Med. 1984;5:31–5.CrossRefPubMed

15.

Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin Sports Med. 2000;10:176–84.CrossRef

16.

Bramante C, Gandolfo L, Bosco V. Minimally invasive fasciotomy in the treatment of chronic exertional anterior compartment syndrome of the leg: personal technique. Chir Ital. 2008;60:711–5.PubMed

17.

Cook S, Bruce G. Fasciotomy for chronic compartment syndrome in the lower limb. ANZ J Surg. 2002;72:720–3.CrossRefPubMed

18.

de Fijter WM, Scheltinga MR, Luiting MG. Minimally invasive fasciotomy in chronic exertional compartment syndrome and fascial hernias of the anterior lower leg: short- and long-term results. Mil Med. 2006;171:399–403.CrossRefPubMed

19.

Martens MA, Backaert M, Vermaut G, Mulier JC. Chronic leg pain in athletes due to a recurrent compartment syndrome. Am J Sports Med. 1984;12:148–51.CrossRefPubMed

20.

Slimmon D, Bennell K, Brukner P, Crossley K, Bell SN. Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg. Am J Sports Med. 2002;30:581–8.PubMed

21.

Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N, et al. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin Sports Med. 2012;22:356–70.CrossRef

22.

Padhiar N, Allen M, King JB. Chronic exertional compartment syndrome of the foot. Sports Med Arthrosc. 2009;17:198–202.CrossRefPubMed

23.

Tsintzas D, Ghosh S, Maffulli N, King JB, Padhiar N. The effect of ankle position on intracompartmental pressures of the leg. Acta Orthop Traumatol Turc. 2009;43:42–8.CrossRefPubMed

24.

Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom. Clin Sports Med. 2006;16:209–13.CrossRef

25.

Ware JE. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25:3130–9.CrossRef

26.

Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72.CrossRefPubMed

27.

Saxena A. Return to athletic activity after foot and ankle surgery: a preliminary report on select procedures. J Foot Ankle Surg. 2000;39:114–9.CrossRefPubMed

28.

Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clin Orthop Relat Res. 1975;113:69–80.CrossRefPubMed

29.

Turnipseed W, Detmer DE, Girdley F. Chronic compartment syndrome. An unusual cause for claudication. Ann Surg. 1989;210:557–63.CrossRefPubMedPubMedCentral

30.

Hutchinson MR, Bederka B, Kopplin M. Anatomic structures at risk during minimal-incision endoscopically assisted fascial compartment releases in the leg. Am J Sports Med. 2003;31:764–9.PubMed

31.

Leversedge FJ, Casey PJ, Seiler JG, Xerogeanes JW. Endoscopically assisted fasciotomy: description of technique and in vitro assessment of lower-leg compartment decompression. Am J Sports Med. 2002;30:272–8.PubMed

32.

Ota Y, Senda M, Hashizume H, Inoue H. Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy. Arthroscopy. 1999;15:439–43.CrossRefPubMed

33.

Mouhsine E, Garofalo R, Moretti B, Gremion G, Akiki A. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. 2006;14:193–7.CrossRefPubMed

34.

Black KP, Schultz TK, Cheung NL. Compartment syndromes in athletes. Clin Sports Med. 1990;9:471–87.PubMed

Title: Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg
Authors: Nicola Maffulli
Mattia Loppini
Filippo Spiezia
Alessio D’Addona
Gayle D. Maffulli
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2016
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-016-0395-9

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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