Association Between Number of Positive Pedowitz Criteria and Outcome After a Fasciotomy for Lower Leg Chronic Exertional Compartment Syndrome

Background: A frequent cause of exercise-induced leg pain in young individuals is chronic exertional compartment syndrome (CECS). The dominant role of a diagnostic intracompartmental pressure (ICP) measurement (ICPM) according to the Pedowitz criteria (PDWc) is criticized. The relation between number of positive PDWc and outcome after surgery for different types of lower leg CECS is unknown. Purpose/Hypothesis: The aim of this study was to determine whether number of positive PDWc is associated with three different outcome parameters in patients who were operated for different types of lower leg CECS. It was hypothesized that the number of positive PDWc is related to outcomes 3 and 12 months after fasciotomy for CECS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with a history and physical examination consistent with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS) completed a questionnaire scoring symptoms prior to an ICPM. Three PDWc were used (ICP >= 15 mmHg before the treadmill test; and ICP >= 30 mmHg and >= 20 mmHg 1 and 5 minutes after the test, respectively). Patients were grouped according to number of positive PDWc (0/1, 2, 3), and CECS type (ant-CECS, dp-CECS). In these 6 groups, outcomes-defined as symptom scores, return to sports, and operation satisfaction-were measured 3 and 12 months after a fasciotomy. Mann-Whitney U, Kruskal-Wallis, and Fisher-Freeman-Halton tests were used. Results: Between February 2013 and January 2025, 182 patients (313 legs; 37% male; age, 25 years [IQR, 19-36], excluding the lateral-CECS group with 5 patients) fulfilled study criteria. Group ant-CECS PDWc 0/1, PDWc 2 and PDWc 3 contained 7, 33, and 93 patients, respectively. Group dp-CECS PDWc 0/1, PDWc 2, and PDWc 3 had 10, 14, and 25 patients, respectively. Five PDWc groups demonstrated a significant drop (P < .01) in symptom scores at 3 and 12 months, but not the ant-CECS PDWc 0/1 group (P = .18; P = .37). This latter group also demonstrated lower return-to-sports rate (50%; P = .04) compared with PDWc 2 and PDWc 3 (74% and 86%, respectively). Operation satisfaction was not associated with number of positive PDWc in either ant-CECS or dp-CECS patients. dp-CECS patients tended to be more satisfied than ant-CECS patients (at 3 months 63% vs 47%; P = .07). Conclusion: Our study demonstrated that there is no uniform association between number of positive PDWc and outcome in patients who were operated for either ant-CECS or dp-CECS. This study can assist in future research in order to contribute to our understanding and to optimize decision making in patients with CECS who are considering fasciotomy.