Is surgery effective for deep posterior compartment syndrome of the leg? A systematic review

Results of surgery for lower leg deep posterior chronic exertional compartment syndrome (dp-CECS) are inferior compared to other types of CECS. Factors influencing suboptimal surgical results are unknown. The purpose of this systematic review was to provide a critical analysis of the existing literature on the surgical management of dp-CECS aimed at identifying parameters determining surgical results.

A literature search was performed using Pubmed, EMBASE, MEDLINE and CINAHL (EBSCO). Studies including surgical results for dp-CECS were systematically reviewed.

7 studies of level III evidence reporting on a total of 131 patients met inclusion criteria (>5 patients, reporting intracompartmental pressures (ICP), clearly stating postoperative outcome). Only four studies strictly adhered to predefined ICP criteria. Cutoff ICP levels varied widely among the 7 studies. Surgical procedures ranged from a superficial crural fasciotomy to multiple fasciotomies of various deep posterior compartments. No single surgical procedure proved superior. Prolonged high ICP levels following provocation were associated with postoperative success. Success rates after fasciotomy were modest ranging from 30% to 65%. Risk factors for failure of surgery were not identified.

The quality of studies reporting on surgery for dp-CECS is poor. Prospective, controlled or randomised studies are lacking. Diagnostic criteria and surgical techniques are diverse. As functional results of current management regimes are disappointing, future studies of dp-CECS should focus on optimising diagnostic criteria and standardisation of treatment modalities.