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Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg.

ABSTRACT: Chronic exertional compartment syndrome (CECS) is a significant source of lower extremity pain and morbidity in the athletic population. Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. The literature on surgical management of CECS is mixed, and overall success rates are modest at best. Optimizing surgical technique, including prevention of neurovascular injury and wound complications, can make a significant impact on the clinical outcome. Here we present our surgical technique, including pearls and pitfalls, for open 4-compartment fasciotomy for treatment of chronic exertional compartment syndrome.

SUBMITTER: Dai AZ

PROVIDER: S-EPMC5766428 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg.

Dai Amos Z AZ Zacchilli Michael M Jejurikar Neha N Pham Hien H Jazrawi Laith L

Arthroscopy techniques 20171120 6

Chronic exertional compartment syndrome (CECS) is a significant source of lower extremity pain and morbidity in the athletic population. Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. The literature on surgical management of CECS is mixed, and overall success rates are modest at best. Optimizing surgical technique, including prevention of neurovascular injury ...[more]

PMID: 29349018

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Project description:BackgroundChronic exertional compartment syndrome (CECS) is primarily seen in running athletes. Previous outcomes of surgical treatment with fasciotomy have suggested moderate pain relief, but evidence is lacking regarding postoperative return to running.HypothesisRunning athletes with limiting symptoms of CECS will show high rates of return to running after fasciotomy.Study designCase series.Level of evidenceLevel 4.MethodsRunning athletes treated with fasciotomy for CECS at a single institution were identified using a surgical database and asked to complete a questionnaire designed to assess postoperative pain, activity level, return to running, running distances, overall satisfaction, and rate of revision fasciotomy.ResultsA total of 43 runners met the inclusion criteria, and 32 runners completed outcomes questionnaires at a mean postoperative follow-up of 66 months. In total, 27 of these 32 patients (84%) returned to sport(s) after fasciotomy. However, 9 (28%) of these patients pursued nonrunning sports, 5 (16%) due to recurrent pain with running. Of the 18 patients who returned to running sports (56%), the mean weekly running distance decreased postoperatively. Recurrence of symptoms was reported in 6 patients (19%), 4 of whom had returned to running and 2 of whom had been unable to return to sports. All of these 6 patients elected to undergo revision fasciotomy surgery. Twenty-five (78.1%) patients reported being satisfied with their procedure. In the overall cohort, the mean visual analog scale scores for pain during activities/sports decreased from 7.9 preoperatively to 1.7 postoperatively.ConclusionFasciotomy for CECS in runners may provide significant improvement in pain and satisfaction in over three-quarters of patients and return to sports in 84% of patients. However, only 56% returned to competitive running activity, with a subset (19%) developing recurrent symptoms resulting in revision surgery.Clinical relevanceFasciotomy has been shown to decrease pain in most patients with CECS. This study provides outcomes in running athletes after fasciotomy for CECS with regard to return to sports, maintenance of sports performance, and rates of revision surgery.

Dataset Information

Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg.

Publications

Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg.

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