scholarly journals Release of Tibialis Posterior Muscle Osseofascial Sheath for Chronic Exertional Compartment Syndrome Leads to Improved Outcomes

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Adam Boissonneault ◽  
Taylor Bellamy ◽  
Sameh Labib
Keyword(s):  
Patient Satisfaction ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Surgical Management ◽  
Activity Level ◽  
Tibialis Posterior ◽  
Success Rates ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome

Category: Sports Introduction/Purpose: Success rates for surgical management of chronic exertional compartment syndrome (CECS) in the lower extremity are influenced by the leg compartment involved. A failure rate of 40-50% has been associated with release of the deep posterior compartment, which has historically been associated with significantly worse outcomes than isolated anterolateral releases. The tibialis posterior muscle often resides in a separate osseofascial sheath, the so-called “fifth compartment.” At our institution, when a deep posterior release is performed, we routinely examine for this fifth compartment and release it if present. Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in those that underwent 2-versus 4-compartment fasciotomy for CECS. Methods: Our study reports on 48 limbs from 31 patients associated with a consecutive series that presented to a single institution for surgical management of lower extremity CECS from 2007-2016. The mean (standard deviation) follow-up was 65 (+/- 28) months. All patients underwent pre-operative intramuscular compartment pressure testing for CECS diagnosis. All surgeries were performed by a single surgeon. In all patients in which 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath. This sheath was released when present. The presence or absence of the sheath was always dictated in the operative note. Patient satisfaction outcomes were assessed with a Likert scale (excellent, good, fair, or poor). Current activity level was assessed via Marx and Tegner activity scores. Results: Of the 48 limbs, 29 limbs received 2-compartment anterolateral releases only and 19 limbs received 4-compartment fasciotomies. Of those that received 4-compartment fasciotomies, 13 (68%) were found to have a separate osseofascial sheath surrounding the tibialis posterior muscle. At a mean 5-year follow-up interval, 77% of the total cohort rated their outcome as good or excellent. Among the 4-comparment fasciotomy sub-cohort, 79% of patients rated their outcome as good or excellent. Among the entire cohort, there were no revision surgeries performed. The overall mean Tegner and Marx activity scores were 6 and 11 respectively. There was no significant difference in mean outcome scores between those that had 2-versus 4-compartment fasciotomies. Conclusion: Our study illustrates that 1) a separate osseofascial sheath exists around the tibialis posterior muscle in the majority of cases and 2) if this fifth compartment is consistently examined for and released, patients can achieve equivalent success rates and return to a similarly high activity level as those that undergo 2-compartment fasciotomy for CECS. Our study demonstrates superior results for 4-compartment release and includes the longest mean follow-up time for CECS patients in the literature.

scholarly journals Release of the Tibialis Posterior Muscle Osseofascial Sheath Improves Results of Deep Exertional Compartment Syndrome Surgery: A Comparative Analysis and Long-term Results

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094275
Author(s):  
J. Taylor Bellamy ◽  
Adam R. Boissonneault ◽  
Morgan E. Melquist ◽  
Sameh A. Labib
Keyword(s):  
Patient Satisfaction ◽  
Compartment Syndrome ◽  
Tibialis Posterior ◽  
Success Rates ◽  
Posterior Compartment ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Exertional Compartment Syndrome

Background: Success rates for surgical management of chronic exertional compartment syndrome (CECS) are historically lower with release of the deep posterior compartment compared with isolated anterolateral releases. At our institution, when a deep posterior compartment release is performed, we routinely examine for a separate posterior tibial muscle osseofascial sheath and release it if present. Purpose: Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in patients who underwent 2-compartment fasciotomy versus a modified 4-compartment fasciotomy for CECS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients treated with fasciotomy for lower extremity CECS from 2007 to 2017 were retrospectively identified. In all patients in whom a 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath, which was released when present. Patients completed a series of validated patient-reported outcome (PRO) surveys, including the Marx activity score, Tegner activity score, 12-Item Short Form Health Survey, and Likert score for patient satisfaction. Results: Of the 48 patients who were included in this study, 34 (71%) patients with a total of 52 operative limbs responded and completed PRO surveys. The mean follow-up for the entire cohort was 5.5 ± 2.6 years. Of the 34 patients, 23 (68%) underwent 2-compartment fasciotomy and 11 (32%) underwent 4-compartment fasciotomy. Among the patients in the 4-compartment fasciotomy group, 7 (64%) were found to have a fifth compartment. No significant difference was found in any of the validated PRO measures between patients who had a 2- versus 4-compartment fasciotomy or those who underwent 4-compartment fasciotomy with or without a present fifth compartment. At a mean 5.5-year follow-up, 74% of patients who underwent a 2-compartment release reported good or excellent outcomes compared with 82% of patients who underwent our modified 4-compartment release. Conclusion: The current study, which included the longest follow-up on CECS patients in the literature, demonstrated that the addition of a release of the posterior tibial muscle fascia led to no significant difference in PRO measures between patients who underwent a 2- versus 4-compartment fasciotomy, when historically the 2-compartment fasciotomy group has had higher success rates.

Patient-Reported Outcomes Following Fasciotomy for Chronic Exertional Compartment Syndrome

2018 ◽  
Vol 11 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Jacqueline M. Maher ◽  
Emily M. Brook ◽  
Christopher Chiodo ◽  
Jeremy Smith ◽  
Eric M. Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Lower Extremity Function ◽  
Five Dimensions ◽  
Chronic Exertional Compartment Syndrome ◽  
Patient Reported ◽  
Exertional Compartment Syndrome

Background. Lower extremity chronic exertional compartment syndrome (CECS) can negatively affect exercise and activity and may require operative intervention to release the fascia. Few studies have evaluated or compared patient-reported outcomes for bilateral versus single-leg staged fasciotomy and number of compartments released. Methods. A total of 27 eligible patients who underwent a fasciotomy procedure for CECS at a single institution were identified. A retrospective review of the medical record was performed, and individuals were contacted by phone to collect patient-reported outcomes, including ability to return to desired exercise level, postoperative expectation assessment, European Quality of Life—Five Dimensions, and the Foot and Ankle Ability Measure sports subscale. Results. A total of 21 patients were available for follow-up (average follow-up 36.9 months). The average single numeric assessment evaluation of lower-extremity function in sport was 87.5% in those who underwent a simultaneous bilateral fasciotomy (n = 10), 94% in those who had a staged unilateral fasciotomy (n = 5), and 74% in those who underwent an isolated single-leg fasciotomy. In all, 91% (n = 10) of patients who had all 4 compartments released intra-operatively were able to return to their desired exercise level versus 66.7% (n = 6) of those who did not have all 4 compartments released. Conclusion. The patient-reported outcomes of a staged unilateral fasciotomy and simultaneous bilateral fasciotomy for CECS are similar. Those who did not have all 4 compartments released reported worse outcomes. Further research should be conducted on the short-term outcomes and cost-effectiveness of a bilateral versus staged fasciotomy procedure. Levels of Evidence: Level IV: Case series

scholarly journals Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy

2011 ◽  
Vol 36 (5) ◽  
pp. 413-419 ◽  
Author(s):  
J. S. Brown ◽  
P. C. Wheeler ◽  
K. T. Boyd ◽  
M. R. Barnes ◽  
M. J. Allen
Keyword(s):  
Compartment Syndrome ◽  
Surgical Intervention ◽  
Case Series ◽  
Chronic Exertional Compartment Syndrome ◽  
Catheter Technique ◽  
Percentage Improvement ◽  
Patient Reported ◽  
Exertional Compartment Syndrome ◽  
Outcome Of Surgery

Chronic exertional compartment syndrome of the forearm is rare in the published literature. We report the outcome of a series of 12 patients treated with fasciotomy over a 14 year period. All patients underwent dynamic intra-compartmental pressure testing using a slit catheter technique before surgery. Raised intra-compartmental pressures on exercise, typical symptoms and the absence of other diagnoses were criteria for offering surgical intervention. The superficial flexor, deep flexor and extensor compartments were released. Median follow-up was 9.5 years (range 7 months to 12 years). Median patient-reported percentage improvement after surgery was 88% (range 0%–100%). Median time to return to full activity was 9 weeks. Eleven out of 12 patients were satisfied, very satisfied or extremely satisfied with the outcome of surgery. Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm.

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 Outcomes of Surgically Treated Chronic Exertional Compartment Syndrome in Runners

2020 ◽  
Vol 12 (3) ◽  
pp. 304-309
Author(s):  
Matthew Salzler ◽  
Kathleen Maguire ◽  
Benton E. Heyworth ◽  
Adam Y. Nasreddine ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Revision Surgery ◽  
Case Series ◽  
Activity Level ◽  
Return To Sports ◽  
Recurrent Pain ◽  
Chronic Exertional Compartment Syndrome ◽  
Running Activity ◽  
Exertional Compartment Syndrome ◽  
The Mean

Background: Chronic 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. Hypothesis: Running athletes with limiting symptoms of CECS will show high rates of return to running after fasciotomy. Study Design: Case series. Level of Evidence: Level 4. Methods: Running 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. Results: A 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. Conclusion: Fasciotomy 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 Relevance: Fasciotomy 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.

scholarly journals Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

2020 ◽  
Author(s):  
Sanne Vogels ◽  
Ewan D. Ritchie ◽  
Henricus PH Hundscheid ◽  
Kim van Someren ◽  
Loes Janssen ◽  
...  
Keyword(s):  
Treatment Group ◽  
Conservative Treatment ◽  
Compartment Syndrome ◽  
Clinical Effectiveness ◽  
Treated Group ◽  
Activity Level ◽  
Sports Activity ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Surgical Group

AbstractThe aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.

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