Good results of fasciotomy in chronic compartment syndrome of the lower leg.

Verleisdonk EJ, van den Helder CJ, Hoogendoorn HA, van der Werken C. Ned Tijdschr Geneeskd 1996 Dec 14;140(50):2513-7.

OBJECTIVE.
To assess the results of fasciotomy in patients with a chronic compartmental syndrome. DESIGN: Retrospective study.

SETTING.
Department of Surgery, Central Military Hospital, Utrecht, the Netherlands. METHOD: Closed fasciotomy was performed in 81 patients (151 compartments) after standardized measurement of the pressure of the symptomatic compartment during exercise. The anterior compartment was affected 149 times and the lateral compartment twice. The pressure reading was repeated at least 3 months after the operation. All operated patients 6 months postoperatively were sent a written questionnaire inquiring about the results of the operation.

RESULTS.
Postoperative complications included a neurinoma (3 times) and a seroma (once). The mean postoperative intramuscular pressures were lower than the preoperative ones: the pressure at rest fell from 22.1 to 14.0 mm Hg (p < 0.05), the exercise pressure from 57.5 to 25.4 mm Hg (p < 0.01) and the relaxation pressure from 34.4 to 25.2 mm Hg (p < 0.05). Tn patients had an unchanged increased pressure after the operation, for which a second fasciotomy was performed 4 times. Attenuation of symptoms was reported by 59 patients (76%). Nine patients with poor results had already had a combination with some other hyperpressure injury before the operation.

CONCLUSION.
Closed fasciotomy in a demonstrated chronic compartmental syndrome in most cases gave good results, viz. attenuation of symptoms and a decrease of the intramuscular pressure, especially after exercise.

Chronic compartment syndrome of the quadriceps femoris muscle in athletes. Diagnosis, imaging and treatment with fasciotomy.

Orava S, Laakko E, Mattila K, Makinen L, Rantanen J, Kujala UM. Ann Chir Gynaecol 1998;87(1):53-8.

BACKGROUND AND AIMS.
Chronic quadriceps femoris muscle compartment syndrome is described.

MATERIAL AND METHODS.
Over a 13 year period nine patients were diagnosed, treated surgically by fasciotomy and followed up at a referral center specialized in sports traumatology. There were four power lifters, three body builders, one endurance walker and one cyclist in the series. The use of anabolic steroids was admitted by four of the nine patients. The patients complained of gradually worsening pain on the anterolateral side of the thigh during training. Initially the pain appeared only at the end of the training session. As the syndrome became more severe, the pain began earlier during exercise and gradually became worse preventing maximal training. Skeletal radiographs and ultrasound examinations were normal, except in two patients, who had a positive echography finding with local atrophy. MRI examination confirmed the US diagnosis.

RESULTS AND CONCLUSIONS.
As conservative treatment did not provide relief of symptoms, a fasciotomy anterior to the iliotibial tract was performed bilaterally to seven patients and unilaterally to two patients. Biopsies from the atrophied sites showed muscle cell necrosis. All the patients recovered well after the surgery and were able return to their original level of sport. The only complication of surgery was a postoperative hematoma in one patient, which delayed the beginning of the training, but did not result in any persistent complaints.

Treatment of chronic exertional anterior compartment syndrome with massage: a pilot study.

Blackman PG, Simmons LR, Crossley KM. Clin J Sport Med 1998 Jan;8(1):14-7.

OBJECTIVE.
To determine the effect of massage on anterior chronic exertional compartment syndrome (CECS) with respect to symptoms, intracompartmental pressures, and work output of the anterior compartment in dorsiflexion.

DESIGN.
One group-repeated measures design.

SETTING.
A private sports medicine clinic in Melbourne, Australia.

PARTICIPANTS.
Seven athletes (six men and one woman), aged between 21 and 29 years, were selected on the basis of clinical suspicion for anterior CECS. Historical questionnaire and examination were followed by intracompartmental pressure testing of the anterior compartment. Study exclusion criteria were history of a bleeding diathesis and previous treatment consisting of compartment fasciotomy or massage. All athletes completed the study.

INTERVENTIONS.
A 5-week course of massage consisting of two sessions in the first week and one session per week thereafter, for a total of six treatments. Between each session, a twice-daily standard stretching program involving both anterior and posterior compartments was performed.

MAIN OUTCOME MEASURES.
Postexercise anterior compartment pressures (mm Hg) before and after treatment, work output (J) in dorsiflexion to pain onset before and after treatment, self-reported symptoms before and after treatment.

RESULTS.
There was no significant difference in the 3-minute postexercise compartment pressures after the treatment. There was a significant (p = 0.016) increase, however, in work performed in dorsiflexion to pain onset following the massage course.

CONCLUSIONS.
Intermittent massage combined with specific stretching should be considered in the treatment of anterior CECS.

Intracompartmental pressure before and after fasciotomy in runners with chronic deep posterior compartment syndrome.

Biedert RM, Marti B. Int J Sports Med 1997 Jul;18(5):381-6.

Exercise induced pain in the posterior part of the leg is common among runners; the underlying reason for these complaints may be very different. The purpose of the present, controlled study was therefore 1. to confirm a clinically diagnosed deep posterior compartment syndrome by using intramuscular pressure measurements and 2. to evaluate the effect of a surgical release on clinical signs and intracompartment pressure values. Fifteen symptomatic runners with the clinical suspicion of a chronic deep posterior compartment syndrome and nine healthy recreational runners as controls were investigated. Intramuscular pressure was measured both at rest and up to two minutes post-exercise, using a pressure-monitor with a transducer. In symptomatic runners, the average pressure was preoperatively 5.6 mmHg (95%-confidence-interval [CI]: 3.4-7.6) at rest, rising to 18.5 mmHg (CI: 15.4-21.8) post-exercise. Corresponding values in healthy control runners were 5.1 mmHg (CI: 1.9-8.3) at rest, with a decrease induced by exercise to 2.8 mmHg (CI: -0.5-6.1). After fasciotomy of the deep posterior compartment in all fifteen symptomatic runners, average pressure values fell to 2.2 mmHg (CI: 1.0-3.4) at rest, and were further reduced after (now pain-free) exercise to 1.6 mmHg (CI: 0.6-2.6). The decrease between pre-operative and post-operative values was statistically highly significant (p < 0.0001 for values after running, p < 0.005 for values at rest). In conclusion, intracompartment pressure measurement is a useful technique to confirm the clinical diagnosis of deep posterior compartment syndrome prior to recommending surgery. Hereby, an exercise-induced rise in pressure of at least 10 mmHg, corresponding to a two- to threefold increase of values measured at rest, may be a more important diagnostic criterion than absolute levels of pressure measured before or after running.