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Systematic Review of Outcome Parameters Following Treatment of Chronic Exertional Compartment Syndrome in the Lower Leg.

ABSTRACT: 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 is to analyze the current evidence regarding treatment outcome of CECS in the lower leg. MATERIAL AND METHODS:A literature search and systematic analysis was 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=3,783; age range 12-70yr; 7:4 male to female ratio). Conservative interventions such as gait retraining (n=2) and botulinum injection (n=1) decreased ICP ( x- =68 mmHg to x- =32 mmHg) and resulted in a 47% (±42%) rate of satisfaction and a 50% (±45%) rate of return to physical activity. Fasciotomy significantly decreased ICP ( x- =76 mmHg to x- =24 mmHg) 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<0.01) 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.

SUBMITTER: Vogels S

PROVIDER: S-EPMC7540008 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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

Vogels Sanne S Ritchie Ewan D ED van Dongen Thijs T C F TTCF Scheltinga Marc R M MRM Zimmermann Wes O WO Hoencamp Rigo R

Scandinavian journal of medicine & science in sports 20200724 10

<h4>Objective</h4>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.<h4>Material and methods</h4>A literature search and systematic analysis were performed according ...[more]

PMID: 32526086

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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.

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Systematic Review of Outcome Parameters Following Treatment of Chronic Exertional Compartment Syndrome in the Lower Leg.

Publications

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

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