Open Surgical Management of Chronic Exertional Compartment Syndrome of the Leg

The purpose of this study is to present one institution's experience managing chronic exertional compartment syndrome (CECS) and to identify patient and surgical characteristics associated with better outcomes following open surgical management of CECS with specific emphasis on return to sports.

Fifteen patients (10 male, 5 female) who underwent open fasciotomy for CECS with a minimum of 1-year follow-up were included. Chart review was performed to obtain patient demographics, medical and surgical history, presenting symptomatology, and surgical details of fasciotomy. Outcomes were assessed using follow-up questionnaires that consisted of Tegner Activity Scale, EuroQol-5D (EQ5D) index score, EQ-5D rating scale, symptom resolution, patient satisfaction, and return to sports.

The mean patient age at the time of surgery was 28.1 years (range: 17 to 49 years). At mean follow-up of 2.7 years (range: 1.0 to 5.1 years), five patients reported complete resolution of symptoms, eight reported improvement (but not resolution) of symptoms, one reported no change in symptoms, and one reported worsening of symptoms. The mean Tegner Activity Score was 6.7 (range: 1 to 9) prior to injury and 4.7 (range: 1 to 9) postoperatively. Patients with any preoperative symptoms at rest had significantly lower Tegner before score (4.0 vs. 7.1, p = 0.036) and EQ5D rating (50.0 vs. 83.5, p = 0.04) compared to those that only experienced symptoms with activity. Patients that had prior surgery, including fasciotomy, had significantly lower EQ-5D rating than patients with no history of prior lower extremity surgery (56.7 vs. 84.6, p = 0.045). Although 10 (66%) patients were able to return to sports, only four (27%) of them were able to return to their prior level of sport. The overall satisfaction rate was 87%.

Although open surgical fasciotomy for treatment of chronic exertional compartment syndrome leads to high rates of symptom improvement or resolution, fewer patients are able to return to their prior level of sports. Presence of symptoms at rest, presence of bilateral symptoms, and history of prior lower extremity surgery all portend worse outcomes.