scholarly journals Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Houston Andrew ◽  
Cosma Georgina ◽  
Turner Phillipa ◽  
Bennett Alexander
Keyword(s):  
Machine Learning ◽  
Compartment Syndrome ◽  
Surgical Outcomes ◽  
Lower Limbs ◽  
Leg Pain ◽  
Success Rates ◽  
Chronic Exertional Compartment Syndrome ◽  
Learning Framework ◽  
Post Surgery ◽  
Exertional Compartment Syndrome

AbstractChronic exertional compartment syndrome (CECS) is a condition occurring most frequently in the lower limbs and often requires corrective surgery to alleviate symptoms. Amongst military personnel, the success rates of this surgery can be as low as 20%, presenting a challenge in determining whether surgery is worthwhile. In this study, the data of 132 fasciotomies for CECS was analysed and using combinatorial feature selection methods, coupled with input from clinicians, identified a set of key clinical features contributing to the occupational outcomes of surgery. Features were utilised to develop a machine learning model for predicting return-to-work outcomes 12-months post-surgery. An AUC of 0.85 ± 0.08 was achieved using a linear-SVM, trained using 6 features (height, mean arterial pressure, pre-surgical score on the exercise-induced leg pain questionnaire, time from initial presentation to surgery, and whether a patient had received a prior surgery for CECS). To facilitate trust and transparency, interrogation strategies were used to identify reasons why certain patients were misclassified, using instance hardness measures. Model interrogation revealed that patient difficulty was associated with an overlap in the clinical characteristics of surgical outcomes, which was best handled by XGBoost and SVM-based models. The methodology was compiled into a machine learning framework, termed AITIA, which can be applied to other clinical problems. AITIA extends the typical machine learning pipeline, integrating the proposed interrogation strategy, allowing to user to reason and decide whether to trust the developed model based on the sensibility of its decision-making.

Chronic exertional compartment syndrome: diagnosis, investigation, management and return to training

2018 ◽  
Vol 104 (2) ◽  
pp. 124-128
Author(s):  
R L Thomas ◽  
R Hemingway ◽  
A Keenan ◽  
A Wood
Keyword(s):  
Compartment Syndrome ◽  
Lower Limbs ◽  
Leg Pain ◽  
Military Recruit ◽  
Chronic Exertional Compartment Syndrome ◽  
Military Recruits ◽  
Exertional Compartment Syndrome ◽  
Poor Outcomes ◽  
Exercise Induced ◽  
The Military

AbstractExercise-induced leg pain is a frequent presenting complaint in military recruits. This has several causes, including chronic exertional compartment syndrome (CECS). The pathophysiology of CECS is debated, but it involves pressure increases in particular compartments and reduced compliance in the epimyseal fascia. Its morbidity and poor outcomes with conservative management lead to extended rehabilitation times, and ultimately to a loss of recruits from training. It has been described in various compartments of the upper and lower limbs, but is most frequently encountered in the leg. It is a condition often encountered in the military recruit, and within this demographic is less common than other causes of exertional lower leg pain. However, its debilitating nature and complicated investigative pathway can cause difficulties, and have notable occupational consequences. This article aims to review the evidence surrounding its diagnosis, treatment, prognosis and the implications for the military patient.

scholarly journals Fasciotomy for Lateral Lower-leg Chronic Exertional Compartment Syndrome

2018 ◽  
Vol 39 (14) ◽  
pp. 1081-1087 ◽  
Author(s):  
Aniek van Zantvoort ◽  
Johan de Bruijn ◽  
Henricus Hundscheid ◽  
Marike van der Cruijsen-Raaijmakers ◽  
Joep Teijink ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Lateral Compartment ◽  
Lower Leg ◽  
Leg Pain ◽  
Success Rates ◽  
Intracompartmental Pressure ◽  
Surgical Success ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome

AbstractExercise-induced lower leg pain may be caused by chronic exertional compartment syndrome (CECS). Anterior or deep posterior compartments are usually affected. Knowledge about CECS of the lateral compartment (lat-CECS) is limited and outcome after fasciotomy is unknown. The purpose of this study is to report on success rates of fasciotomy in patients with lat-CECS. Surgical success rates in patients with lat-CECS diagnosed with a dynamic intracompartmental pressure (ICP) measurement were studied using a questionnaire (success: excellent or good as judged by the patient; unsuccessful: moderate, fair or poor). We conducted ICP measurements in 247 patients for suspected lat-CECS, of whom 78 were positively diagnosed. Following exclusion (n=11), 30 of the eligible 67 patients completed the questionnaire. Bilateral (70%, n=21/30) exertional pain (97%, n=29) and a feeling of tightness (93%, n=28) were the most frequently reported symptoms. Four years after fasciotomy, severity and frequency of symptoms had dropped significantly. Long-term surgical success was reported by 33% (n=10; excellent n=4, good n=6). Seventy-three percent (n=22) had resumed sports activities (9 same level, 13 lower level). In conclusion, a fasciotomy for lat-CECS was successful in the long term in just one of three operated patients in this retrospective study.

scholarly journals Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

2017 ◽  
Vol 39 (01) ◽  
pp. 58-66 ◽  
Author(s):  
Johan de Bruijn ◽  
Aniek van Zantvoort ◽  
David van Klaveren ◽  
Michiel Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Predictive Model ◽  
Pressure Measurement ◽  
Large Population ◽  
Lower Leg ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Discriminative Ability ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome

AbstractKnowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20–25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

Historic cohort: outcome of chronic exertional compartment syndrome-suspected patients

2020 ◽  
pp. jramc-2019-001290
Author(s):  
Roy Maksymiak ◽  
E Ritchie ◽  
W Zimmermann ◽  
N Maliko ◽  
M van der Werve ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Leg Pain ◽  
Future Research ◽  
Intracompartmental Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Patient Demographics ◽  
Military Recruits ◽  
Exertional Compartment Syndrome ◽  
Historic Cohort

IntroductionExercise-related leg pain (ERLP) may be caused by chronic exertional compartment syndrome (CECS), occurring mainly in athletes and military recruits. In military populations, the effectiveness of surgical treatment in CECS is debated. The purpose of this study is to assess the outcome of surgical treatment for CECS in Alrijne Hospital (the Netherlands), a civilian hospital with supraregional referral function.MethodsA historic cohort study was performed on patients with ERLP who were suspected for CECS and were referred for intracompartmental pressure measurement (ICPM) from 2013 to 2017 (n=160). Patient demographics, ICPM and survey response were analysed.ResultsThe mean delay before visitation was 29.0±30.3 months. When comparing surgical-treated patients with CECS with conservative-treated patients with ERLP, surgical-treated patients were more satisfied, reported better recovery towards former level of performance (2.8±2.0 vs 3.9±1.7 and 2.5±1.6 vs 3.2±1.4 on a 7-point Likert scale, respectively) and better subjective injury status (79.3±22.6 vs 63.5±27.4 using the Single Assessment Numeric Evaluation score). Treatment satisfaction was 75.0% in surgical-treated CECS versus 51.4% in conservative-treated ERLP.ConclusionCivilian patients report improved functional outcomes after fasciotomy for CECS. Future research should focus on non-invasive diagnostic options and methods to determine which treatment is the most appropriate for each individual patient.

scholarly journals Outcome following mini-open lower limb fasciotomy for chronic exertional compartment syndrome

2021 ◽  
Author(s):  
William M. Oliver ◽  
Dominic Rhatigan ◽  
Samuel P. Mackenzie ◽  
Timothy O. White ◽  
Andrew D. Duckworth ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Lower Limb ◽  
Return To Sport ◽  
Leg Pain ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
The Mean ◽  
Active Adults ◽  
Eq Vas ◽  
Mini Open

AbstractPurposeThe aim of this study was to report outcomes following mini-open lower limb fasciotomy (MLLF) in active adults with chronic exertional compartment syndrome (CECS).MethodsFrom 2013–2018, 38 consecutive patients (mean age 31 years [16–60], 71% [n = 27/38] male) underwent MLLF. There were 21 unilateral procedures, 10 simultaneous bilateral and 7 staged bilateral. There were 22 anterior fasciotomies, five posterior and 11 four-compartment. Early complications were determined from medical records of 37/38 patients (97%) at a mean of four months (1–19). Patient-reported outcomes (including EuroQol scores [EQ-5D/EQ-VAS], return to sport and satisfaction) were obtained via postal survey from 27/38 respondents (71%) at a mean of 3.7 years (0.3–6.4).ResultsComplications occurred in 16% (n = 6/37): superficial infection (11%,n = 4/37), deep infection (3%,n = 1/37) and wound dehiscence (3%,n = 1/37). Eight per cent (n = 3/37) required revision fasciotomy for recurrent leg pain. At longer-term follow-up, 30% (n = 8/27) were asymptomatic and another 56% (n = 15/27) reported improved symptoms. The mean pain score improved from 6.1 to 2.5 during normal activity and 9.1 to 4.7 during sport (bothp < 0.001). The mean EQ-5D was 0.781 (0.130–1) and EQ-VAS 77 (33–95). Of 25 patients playing sport preoperatively, 64% (n = 16/25) returned, 75% (n = 12/16) reporting improved exercise tolerance. Seventy-four per cent (n = 20/27) were satisfied and 81% (n = 22/27) would recommend the procedure.ConclusionMLLF is safe and effective for active adults with CECS. The revision rate is low, and although recurrent symptoms are common most achieve symptomatic improvement, with reduced activity-related leg pain and good health-related quality of life. The majority return to sport and are satisfied with their outcome.

scholarly journals Chronic Exertional Compartment Syndrome in a High School Soccer Player

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
James J. Bresnahan ◽  
William L. Hennrikus
Keyword(s):  
High School ◽  
Compartment Syndrome ◽  
Soccer Player ◽  
Rare Condition ◽  
Leg Pain ◽  
Intramuscular Pressure ◽  
Compartment Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Life Improvement

Chronic exertional compartment syndrome (CECS) is a relatively rare condition that affects young adult athletes and often causes them to present to the emergency department. If left untreated, those who continue to compete at high levels may experience debilitating leg pain. Physicians may have difficulty differentiating CECS from other syndromes of the lower leg such as medial tibial stress syndrome, stress fractures, and popliteal artery entrapment. The gold standard for diagnosing CECS is intramuscular compartment pressure monitoring before and/or after 10 minutes of exercise. Some patients may choose to stop participation in sports in order to relieve their pain, which otherwise does not respond well to nonoperative treatments. In patients who wish to continue to participate in sports and live an active life, fasciotomy provides relief in 80% or more. The typical athlete can return to training in about 8 weeks. This is a case of a high school soccer player who stopped competing due to chronic exertional compartment syndrome. She had a fascial hernia, resting intramuscular pressure of 30 mmHg, and postexercise intramuscular pressure of 99 mmHg. Following fasciotomy she experienced considerable life improvement and is once again training and playing soccer without symptoms.

scholarly journals Diagnosis of chronic exertional compartment syndrome by post-exercise MRI

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0000
Author(s):  
Vicente Paús ◽  
Ariel Graieb ◽  
Federico Torrengo ◽  
Francisco Villalba
Keyword(s):  
Compartment Syndrome ◽  
Gold Standard ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Post Exercise ◽  
Chronic Exertional Compartment Syndrome ◽  
Hyperintense Signal ◽  
Exertional Compartment Syndrome ◽  
Attractive Option ◽  
Post Stress

Objective: Chronic exertional compartment syndrome (CECS) is the cause of 27% of anterior leg pain in athletes. The source of pain in this condition is still debated. Measurement of intracompartmental pressure is the gold standard diagnosis, albeit an invasive study. The development and interpretation of new MRI sequences has provided a non-invasive alternative to CECS diagnosis. Post-exercise MRI is an attractive option, which is currently undergoing its validation process. Methods: 22 patients with a clinical diagnosis of CECS were included, with a median follow-up of 5 years (1-10 years). All the patients were evaluated by clinical examination, pre- and post-exercise MRI and pre-and post-exercise intracompartmental pressure measurement. Pressure was measured with Whitesides technique, and diagnosis was carried out by Pedowitz criteria. Results: Out of the total 22 patients, 19 had positive intracompartmental measurement (15 male, 4 female) and 3 had negative measurement. All the patients had a normal MRI at rest. The three patients who had negative intracompartmental measurement had a normal post-stress MRI. Out of the remaining 19 patients, the MRI detected hyperintense signal in T2 and STIR weighted in 15 of them (78,95%). Conclusions: MRI could be relevant for diagnosis, for which case the sensitivity of this method should be improved. Nevertheless, pre- and post-stress intracompartmental measurement continues to be the gold standard.

scholarly journals Lower Leg Chronic Exertional Compartment Syndrome in Patients 50 Years of Age and Older

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711875717 ◽  
Author(s):  
Johan A. de Bruijn ◽  
Aniek P.M. van Zantvoort ◽  
Michiel B. Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
Adwin R. Hoogeveen ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Older Patients ◽  
Lower Leg ◽  
Leg Pain ◽  
Older Individuals ◽  
Younger Patients ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Exercise Induced ◽  
Lower Leg Pain

Background: Lower leg chronic exertional compartment syndrome (CECS) is usually diagnosed in young and athletic individuals. The presence of CECS in older patients has received little attention in the literature, and patient characteristics are unknown. Purpose: To determine the prevalence of CECS in older patients (≥50 years) and to assess whether older patients with CECS differ clinically from younger patients with CECS. Study Design: Cohort study; Level of evidence, 3. Methods: All individuals with exercise-induced lower leg pain who visited a referral center for CECS between January 2001 and December 2013 were eligible for analysis. Patients were included if history, physical examination, and dynamic intracompartmental pressure measurement indicated CECS. Characteristics of patients 50 years of age or older were compared with characteristics of patients younger than 50. Results: A total of 698 patients with CECS were included: 98 patients were aged 50 years or older and 600 patients were younger than 50 years. Older individuals more often reported a history of lower leg events or comorbidities (≥50 years, 45% vs <50 years, 25%; P < .01) and unilateral symptoms (≥50 years, 45% vs <50 years, 22%; P < .01). Most older patients (62%) did not participate in sport or only walked or hiked, whereas the same was true of only 7% of the younger population. Pain (≥50 years, 94%; <50 years, 96%) and tightness (≥50 years, 57%; <50 years, 62%) were the predominant symptoms of CECS in both groups. Type of CECS differed significantly ( P < .01); the anterior muscle compartment was involved more frequently in older patients (≥50 years, 82% vs <50 years, 59%) and deep flexor muscle CECS was more often diagnosed in younger patients (≥50 years, 26% vs <50 years, 53%). Conclusion: In the present population, 1 in 7 patients diagnosed with lower leg CECS was 50 years of age or older. These individuals were less active and had more comorbidities than patients younger than 50 years. Older individuals predominantly have anterior CECS. Clinicians should consider CECS in older individuals with exercise-induced lower leg pain, particularly if it is unilateral.

scholarly journals Isolated Lateral Chronic Exertional Compartment Syndrome of the Leg: A New Entity?

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989010 ◽  
Author(s):  
Antonia P.M. van Zantvoort ◽  
Henricus P.H. Hundscheid ◽  
Johan A. de Bruijn ◽  
Adwin R. Hoogeveen ◽  
Joep A.W. Teijink ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Case Series ◽  
Lateral Compartment ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Level Of Evidence ◽  
Anterior Compartment ◽  
Chronic Exertional Compartment Syndrome ◽  
Skin Sensation ◽  
Exertional Compartment Syndrome

Background: Chronic exertional compartment syndrome (CECS) mostly occurs in the anterior or deep posterior compartments (ant-CECS and dp-CECS, respectively) of the leg. It is generally accepted that CECS of the third or lateral compartment (lat-CECS) always occurs together with ant-CECS. However, whether exertional leg pain (ELP) can be caused by an isolated form of lat-CECS is unknown. Purpose: To determine the existence of isolated lat-CECS and study whether history taking and a physical examination aid in discriminating between different subtypes of CECS. Study Design: Case series; Level of evidence, 4. Methods: Patients were eligible for this single-center study, conducted between January 2013 and February 2018, if they reported anterolateral ELP and completed a questionnaire scoring the frequency and intensity of pain, tightness, cramps, muscle weakness, and paresthesia during rest and exercise. They were asked to mark areas of altered foot skin sensation, if present, on a drawing. All patients underwent a dynamic intracompartmental pressure (ICP) measurement of the anterior and lateral compartments simultaneously. The diagnosis of CECS was confirmed by elevated ICP (Pedowitz criteria). There were 3 patient groups: (1) isolated ant-CECS with elevated ICP in the anterior compartment and normal ICP in the lateral compartment, (2) isolated lat-CECS with elevated ICP in the lateral compartment but normal ICP in the anterior compartment, and (3) ant-/lat-CECS with elevated ICP in both the anterior and lateral compartments. Results: A total of 73 patients with anterolateral ELP fulfilled study criteria (isolated ant-CECS: n = 26; isolated lat-CECS: n = 5; ant-/lat-CECS: n = 42). Group differences were not observed regarding age (isolated ant-CECS: median, 26 years [range, 13-68 years]; isolated lat-CECS: median, 20 years [range, 17-63 years]; ant-/lat-CECS: median, 28 years [range, 17-57 years]; χ2 (2) = 0.466; P = .79), sex (isolated ant-CECS: 50% male; isolated lat-CECS: 40% male; ant-/lat-CECS: 62% male; P = .49), or bilateral symptoms (isolated ant-CECS: 54%; isolated lat-CECS: 80%; ant-/lat-CECS: 69%; P = .40). However, cramps at rest were present in a portion of the patients with isolated ant-CECS (38%) and ant-/lat-CECS (57%) but not in those with isolated lat-CECS ( P = .032). Patient drawings of altered foot skin sensation did not contribute to the diagnosis ( P = .92). ICP values after provocation were all lower in patients with isolated ant-CECS and isolated lat-CECS compared with those with ant-/lat-CECS ( P < .05). Conclusion: Seven percent of patients with CECS and anterolateral ELP who had symptoms due to isolated lat-CECS in the presence of normal muscle pressure in the anterior compartment.

Sign in / Sign up

Export Citation Format

Share Document