Long-Term Results of Fasciotomy of the Anterior Compartment in Patients with Exercise-Induced Pain in the Lower Leg

Abstract

This prospective study aims to describe the results of fasciotomy in patients with exercise-induced pain in the lower leg with suspected (chronic) exertional compartment syndrome. The diagnosis of (chronic) exertional compartment syndrome was made if pain in the lateral side of the lower leg after a standard physical load was accompanied by elevated tissue pressures in the anterior muscle compartment. Tissue measurements were performed in 114 patients. In 56 patients (106 compartments) increased tissue pressure was found (> 50 mmHg measured immediately after exercise, or > 30 mmHg if the pressure before exercise > 20 mmHg, or if the pressure five minutes after exercise is still > 30mmHg). Two years after fasciotomy, (remaining) complaints were evaluated on the basis of a questionnaire: 87 % of the patients had significant reduction in complaints. Patients who were not found to have increased tissue pressure were also asked to report developments through the questionnaire. In 18 patients a fasciotomy was performed on the basis of the typical history, despite normal or slightly increased intramuscular pressures. Twelve of these patients (24 compartments) were asymptomatic after surgery. Fasciotomy in patients with a (chronic) exercise-induced compartment syndrome in the anterior compartment of the lower leg, based on our criteria, gave a marked reduction in symptoms in 87 % of the patients. Further research has to be done for the minimum tissue pressures above which fasciotomy may be successful in terms of reducing complaints.

Key words

Elevated pressure compartment - fasciotomy

References

• 1 Abramowitz A J, Schepsis A A. Chronic exertional compartment syndrome of the lower leg.  Orth Rev. 1994;  23 219-25
• 2 Allen M J, Barnes M R. Exercise pain in the lower leg.  J Bone Joint Surg. 1986;  68B 818-822
• 3 Allen M J. Compartment syndromes of the lower limb.  J Royal Coll Surg Edinb. 1990;  35 33-36
• 4 Awbrey B J, Sienkiewicz P S, Mankin H J. Chronic exercise induced compartment pressure elevation measured with a miniaturized fluid pressure monitor.  Am J Sports Med. 1988;  16 610-615
• 5 Detmer D E, Sharpe K, Sufit R L, Girdley F M. Chronic compartment syndrome: diagnosis, management, and outcomes.  Am J Sports Med. 1985;  13 162-170
• 6 Folkow B, Gaskell P, Waaler B A. Bloodflow through limb muscles during heavy rhytmic exercise.  Acta Physiol Scand. 1970;  80 61-72
• 7 Fronek J, Mubarak S J, Hargens A R. Management of chronic exertional anterior compartment syndrome of the lower extremity.  Clin Orth Rel Res. 1987;  220 217-226
• 8 Howell J N, Chleboun G, Conatser R. Muscle stifness, strength loss, swelling and soreness following exercise-induced injury in humans.  J Physiol. 1993;  464 183-196
• 9 Matsen F A, Rorabeck C H. Compartmental syndromes.  Instr Course Lect. 1989;  38 463-472
• 10 Mc Dermott AGP, Marble A E, Yabsley R H. Monitoring dynamic anterior compartment pressure during exercise.  Am J Sports Med. 1982;  10 83-89
• 11 Moed B R, Thorderson P K. Measurement of intracompartmental pressure: a comparison of the slit catheter, side ported needle and simple needle.  J Bone Joint Surg. 1993;  75 (B) 231-235
• 12 Mubarak S J, Owen C A. Double incision fasciotomy of the leg for decompression in compartment syndromes.  J Bone Joint Surg. 1977;  59A 184-187
• 13 Pedowitz R A, Hargens A R, Mubarak S J, Gershuni D H. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.  Am J Sports Med. 1990;  18 35-40
• 14 Puranen J, Alavaikko A. Intracompartmental pressure increase on exertion in patients with chronic compartment syndrome in the leg.  J Bone Joint Surg. 1981;  63-A 1304-1309
• 15 Qvarfordt P, Christenson J T, Eklof B, Olin P, Saltin B. Intramuscular pressure, muscle blood flow and skeletal muscle metabolism in chronic anterior tibial compartment syndrome.  Clin Orth Rel Res. 1983;  179 284-290
• 16 Reneman R S. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles.  Clin Orth Rel Res. 1975;  113 69-80
• 17 Rorabeck C H, Macnab I. The pathofysiology of the anterior tibial compartmental syndrome.  Clin Orth Rel Res. 1975;  113 52-57
• 18 Rorabeck C H, Bourne R B, Fowler P J. The Surgical treatment of exertional compartment syndrome in athletes.  J Bone Joint Surg. 1983;  65(A) 1245-1251
• 19 Rorabeck C H, Bourne R B, Fowler P J. The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome.  Am J Sports Med. 1988;  16 143-146
• 20 Schepsis A A, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg.  Am J Sports Med. 1993;  6 811-817
• 21 Styf J R, Korner L. Microcapillary infusion technique for measurement of intramuscular pressure during exercise.  Clin Orth Rel Res. 1986;  207 253-262
• 22 Styf J, Korner L. Intramuscular pressure and muscle blood flow during exercise in chronic compartment syndrome.  J Joint Bone Surg. 1987;  69-B 301-305
• 23 Styf J R, Korner L M. Chronic anterior compartment syndrome of the leg.  J Bone Joint Surg. 1986;  68A 1338-1347
• 24 Styf J. Chronic exercise induced pain in the anterior aspect of the lower leg, an overview of diagnosis.  Sports Med. 1989;  7 331-339
• 25 Styf J. Diagnosis of chronic compartment syndrome in the leg by history, signs and intramuscular pressure recordings. In: Willy C, Sterk J, Gerngros H (eds) Das Kompartmentsyndrom. Hefte zu “der Unfallchirurg”. Springer Verlag 1997 267: 277-281
• 26 Turnipseed W, Detmer D E, Girdley F. Chronic compartment syndrome.  Ann surg. 1989;  210 557-563
• 27 Verleisdonk E JMM, van den Helder C JM, Hoogendoorn H A, van der Werken C. Goede resultaten van fasciotomie bij het chronisch compartimentsyndroom van het onderbeen.  NTvG. 1996;  50 2513-2517
• 28 Wallensten R. Results of fasciotomy in patients with medial tibial syndrome or chronic anterior-compartment syndrome.  J Bone Joint Surg. 1983;  65 1252-1255