Role of Repeat Muscle Compartment Pressure Measurements in Chronic Exertional Compartment Syndrome of the Lower Leg

Aniek P. M. van Zantvoort, Johan A. de Bruijn, Michiel B. Winkes, Adwin R. Hoogeveen, Joep A. W. Teijink, Marc R. Scheltinga*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

Background: The diagnostic gold standard for diagnosing chronic exertional compartment syndrome (CECS) is a dynamic intracompartmental pressure (ICP) measurement of the muscle. The potential role of a repeat ICP (re-ICP) measurement in patients with persistent lower leg symptoms after surgical decompression or with ongoing symptoms after an earlier normal ICP is unknown.

Purpose: To study whether re-ICP measurements in patients with persistent CECS-like symptoms of the lower leg may contribute to the diagnosis of CECS after both surgical decompression and a previously normal ICP measurement.

Study Design: Case series; Level of evidence, 4.

Methods: Charts of patients who underwent re-ICP measurement of lower leg compartments (anterior [ant], deep posterior [dp], and/or lateral [lat] compartments) between 2001 and 2013 were retrospectively studied. CECS was diagnosed on the basis of generally accepted cutoff pressures for newly onset CECS (Pedowitz criteria: ICP at rest 15 mmHg, 30 mmHg after 1 minute, or 20 mmHg 5 minutes after a provocative test). Factors predicting recurrent CECS after surgery or after a previously normal ICP measurement were analyzed.

Results: A total of 1714 ICP measurements were taken in 1513 patients with suspected CECS over a 13-year observation period. In all, 201 (12%) tests were re-ICP measurements for persistent lower leg symptoms. Based on the proposed ICP cutoff values, CECS recurrence was diagnosed in 16 of 62 previously operated compartments (recurrence rate, 26%; 53 patients [64% female]; median age, 24 years; age range, 15-78 years). Recurrence rates were not different among the 3 lower leg CECS compartments (ant-CECS, 17%; dp-CECS, 33%; lat-CECS, 30%; (2) = 1.928, P = .381). Sex ((2) = 0.058, P = .810), age (U = 378, z = 1.840, P = .066), bilaterality ((2) = 0.019, P = .889), and prefasciotomy ICP did not predict recurrence. Re-ICP measurements evaluating 20 compartments with previously normal ICP measurements (15 patients [53% female]; mean age, 31 10 years) detected CECS in 3 compartments (15%, all ant-CECS).

Conclusion: Previous fasciotomy for lower leg CECS or previously normal muscle pressure (ICP) do not rule out CECS as a cause of persisting lower leg symptoms. Repeat ICP measurement may have a potential role in the evaluation of patients with persistent lower leg complaints. However, other reasons for lower leg exertional pain must always be considered prior to secondary surgery.

Original languageEnglish
Article number2325967117711121
Number of pages6
JournalOrthopaedic Journal of Sports Medicine
Volume5
Issue number6
DOIs
Publication statusPublished - 9 Jun 2017

Keywords

  • intracompartmental pressure measurement
  • muscle compartment pressure
  • repeated ICP
  • CECS
  • chronic exertional compartment syndrome
  • INTRACOMPARTMENTAL PRESSURE
  • ANTERIOR COMPARTMENT
  • LOWER-EXTREMITY
  • PARTIAL FASCIECTOMY
  • FASCIOTOMY
  • PAIN
  • DIAGNOSIS
  • OUTCOMES
  • SPECTROSCOPY
  • CLAUDICATION

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