Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome

Abstract

Background: Chronic exertional compartment syndrome (CECS) causes exercise-induced leg pain. The diagnosis is confirmed by intramuscular pressure (IMP) measurements. Fasciotomy has been demonstrated to be a successful treatment for CECS; however, few studies have examined postoperative IMP and long-term outcomes.

Purpose: To evaluate long-term outcomes and postoperative IMP in patients surgically treated for anterior CECS, and to identify possible preoperative or postoperative factors associated with overall satisfaction with treatment at follow-up.

Study design: Case-control study; Level of evidence, 3.

Methods: A consecutive series of 209 patients who underwent fasciotomy of the anterior compartment for CECS between 2009 and 2019 and had at least 1 year of follow-up were approached for inclusion. A total of 144 patients (69%), with a follow-up time of 1 to 11.5 years, were ultimately included. All patients underwent preoperative and postoperative 1-minute postexercise IMP measurements of the anterior compartment and completed a questionnaire covering pain and activity parameters at both time points. The follow-up questionnaire included an additional question on overall satisfaction with treatment, and surgical details were collected from the patient's medical records.

Results: The median IMP was significantly lower at follow-up than at baseline (17 mm Hg [range, 5-91 mm Hg] vs 49 mm Hg [range, 25-130 mm Hg]; P < .001). The overall satisfaction rate was 77%, and 83% reported a decreased pain level. The group of patients who were satisfied with the treatment included more men and had a higher ΔIMP and a lower revision rate (P < .05). Among the 16 patients (11%) who had undergone revision fasciotomies before follow-up, the satisfaction rate was 56%, and 64% reported a decrease in pain level.

Conclusion: Fasciotomy significantly reduced 1-minute postexercise IMP in patients with CECS and resulted in satisfaction and decreased pain in more than three-quarters of the patients at long-term follow-up. The male sex and a significant decrease in IMP were both positively associated with treatment satisfaction. Patients who underwent revision surgery before the follow-up had lower satisfaction rates and less pain reduction than the overall group.

Keywords: chronic anterior compartment syndrome; chronic exertional compartment syndrome; fasciotomy; intracompartmental pressure; intramuscular pressure.

Figure 1.

A flow chart with details of participant inclusion. CECS, chronic exertional compartment syndrome; IMP, intramuscular pressure.

Figure 2.

Distribution of the 1-minute postexercise IMP values preoperatively and at follow-up after fasciotomy of the anterior compartment for (A) the total study group (N = 144), (B) the primary surgery group (n = 128), and (C) the revision surgery group (n = 16). Note the different scales on the y-axis. IMP, intramuscular pressure.

Figure 3.

Satisfaction with the treatment results in patients at follow-up after fasciotomy of the anterior compartment for the total study group (N = 144) and the subgroups: the primary surgery group (n = 128) and the revision surgery group (n = 16).

Figure 4.

Satisfaction with the treatment results in patients at follow-up after fasciotomy of the anterior compartment in relation to the surgical procedure (unilateral, bilateral performed in stages, or bilateral performed concomitantly) for the primary surgery group (n = 128).