Abstract
BACKGROUND: Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS: All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP?=?15?mm Hg at rest, and/or =30?mm Hg after 1?minute, and/or =20?mm Hg 5?minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS: A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n?=?10; lat/ant CECS n?=?54, lat/ant/dp CECS n?=?19, lat/dp CECS n?=?5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n?=?2; lat/ant CECS n?=?22, lat/ant/dp CECS n?=?3, lat/dp CECS n?=?1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n?=?3; temporary complex regional pain syndrome with spontaneous recovery, n?=?1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION: One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE: Level IV, case series.
Original language | English |
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Pages (from-to) | 1097 - 1104 |
Number of pages | 8 |
Journal | Foot & Ankle International |
Volume | 44 |
Issue number | 11 |
Early online date | 19 Sept 2023 |
DOIs | |
Publication status | Published - Nov 2023 |
Keywords
- CECS
- chronic exertional compartment syndrome
- lateral compartment
- lower leg