The present study evaluates the efficacy of two treatment regimens in individuals possibly suffering from chronic exercise induced compartment syndrome (CECS) of the deep posterior compartment of the leg. We hypothesised that the current method of fasciotomy of the deep posterior compartment of the leg is a procedure with a limited success rate. Dynamic intra-compartmental pressure measurements were applied to 46 patients that had symptomatology of a posterior CECS. Only those patients that met predefined pressure criteria, the “high-pressure group” (27 patients), were offered surgical treatment in the form of fasciotomy. The other 19 patients, “low-pressure group”, received conservative treatment, consisting of inlays and physiotherapy. In addition, these patients were examined more closely in order to exclude different pathology. Efficacy of both approaches was evaluated by a questionnaire after a mean three-year follow-up. Fifty-two percent of the high-pressure group judged their operation successful, whereas 48 % did not. The majority of the low-pressure group (84 %) was free of symptoms, after conservative treatment as well as following treatment of other pathology. The present study shows that the success rate of patients surgically treated for posterior CECS is relatively low (52 %). The established cut-off points for the compartment pressure to deselect patients for an operation are justified based on the long-term success rate of the low-pressure group.
2
Birtles D, Rayson M P, Casey A, Jones D A, Newham D IJ.
Venous obstruction in healthy limbs: a model for chronic compartment syndrome.
Med Sci Sports Exerc.
2003;
35
1638-1644
3
Boody A, Wongworawat M.
Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices.
J Bone Joint Surg [Am].
2005;
87
2415-2422
5
Davey J, Rorabeck C, Fowler P.
The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome.
Am J Sports Med.
1984;
12
391-397
9
Howard J, Mohtadi N, Wiley J.
Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg.
Clin J Sport Med.
2000;
10
176-184
12
Mohler L R, Styf J R, Pedowitz R A, Hargens A R.
Intracompartmental pressure and intramuscular PO2 in chronic compartment syndrome of the leg.
J Bone Joint Surg [Am].
1997;
79
844-849
15
Rorabeck C, Fowler P, Nott L.
The results of fasciotomy in the management of chronic exertional compartment syndrome.
Am J Sports Med.
1988;
16
224-227
18
Slimmon D, Bennell K, Brukner P, Crossley K, Bell S.
Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg.
Am J Sports Med.
2002;
30
581-588
19
Soffer S, Martin D, Stanish W, Michael R.
Chronic compartment syndrome caused by aberrant fascia in an aerobic walker.
Med Sci Sports Exerc.
1991;
23
304-306
23
Touliopopoulos S, Hershman E.
Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg.
Sports Med.
1999;
27
193-204
24
van den Brand J, Verleisdonk E, van der Werken C.
Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome.
Am J Sports Med.
2004;
32
452-456
25
Verleisdonk E, Schmitz R F, van der Werken C.
Long-term results of fasciotomy of the anterior compartment in patients with exercise-induced pain in the lower leg.
Int J Sports Med.
2004;
25
224-229