Fasciotomy for exertional anterior compartment syndrome: is lateral compartment release necessary?

The standard surgery for exertional anterior compartment syndrome is fasciotomy of the anterior and lateral compartments of the leg. We prospectively studied the necessity of lateral compartment release, which can add morbidity and extend recovery. We performed 30 anterior compartment releases in 20 patients (10 bilateral operations) with exertional anterior compartment syndrome but not lateral compartment involvement. We alternately performed only an anterior compartment release or both anterior and lateral compartment releases on 10 patients. The 10 patients who underwent bilateral surgery each had, during the same surgery, an anterior and lateral compartment release on one leg and only an anterior compartment release on the other. All were athletes involved in running sports. Overall, satisfactory outcomes were seen in 90% of the limbs--93% (14 of 15) that had anterior compartment release and 87% (13 of 15) that had release of both compartments (no statistically significant difference). For the patients who had unilateral surgery, the average time for full return to sports was 8.1 weeks after anterior release only and 11.4 weeks after release of both compartments, a statistically significant difference. The average time for full return to sports after bilateral surgery was 12.1 weeks. Among these patients, seven said that the leg with only anterior release seemed to recover faster. We concluded that when doing a fasciotomy for exertional anterior compartment syndrome alone, a lateral compartment release is not necessary.