Michiel B Winkes1, Aniek P M van Zantvoort2, Johan A de Bruijn2, Stef J M Smeets2, Marike van der Cruijsen-Raaijmakers3, Adwin R Hoogeveen3, Marc R Scheltinga4. 1. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands m.winkes@mmc.nl. 2. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands. 3. Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands. 4. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands CARIM Research School, Maastricht University, Maastricht, the Netherlands.
Abstract
BACKGROUND: Patients with exercise-induced lower leg pain may suffer from deep posterior chronic exertional compartment syndrome (dp-CECS). Current evidence for the efficacy of surgery is based on retrospective studies. Effects of fasciotomy on symptoms associated with dp-CECS have not been systematically studied, and reasons for unsuccessful surgery are unknown. PURPOSE: To report the short- and long-term effects of fasciotomy on pain, tightness, and cramps in a prospective cohort of patients with isolated dp-CECS. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between September 2011 and January 2015, pain, tightness, cramps, muscle weakness, and diminished sensation were scored (5-item verbal rating scale ranging from very severe [5 points] to absent [1 point]) in patients with dp-CECS before and after fasciotomy. Outcomes were graded as excellent, good, moderate, fair, or poor. Fair and poor cases were again analyzed during a follow-up visit in the outpatient department. RESULTS: Forty-four patients underwent surgery for isolated dp-CECS. Short-term follow-up (median, 4 months; range, 3-7 months) was complete in 42 of the 44 patients (95%; median patient age, 23 years; 23 male; 64 operated legs). Long-term follow-up (median, 27 months; range, 12-42 months) was complete in 34 of 37 eligible patients (92%). Before surgery, exertional pain was very severe (27%) or severe (61%). Fasciotomy improved all symptoms, both in the short term (preoperative vs postoperative pain, 4.1 ± 0.6 vs 2.3 ± 1.1; P < .001) and the long term (pain, 4.2 ± 0.6 vs 2.7 ± 1.3; P < .001). Levels of tightness, cramps, muscle weakness, and diminished sensation demonstrated similar significant improvements. Short- and long-term symptom scores did not differ. The short-term outcome was excellent in 29%, good in 29%, moderate in 21%, fair in 12%, and poor in 10% of patients. In the long term, outcomes were similar (excellent, 12%; good, 35%; moderate, 24%; fair, 18%; and poor, 12%). An unsatisfactory outcome (fair or poor) was often caused by alternative types of CECS (eg, anterior or lateral CECS) or to medial tibial stress syndrome. Based on their outcome, 76% of patients would opt for surgery again. CONCLUSION: Fasciotomy was beneficial in 71% of patients with dp-CECS in the lower leg; 47% of study patients experienced a good to excellent outcome. Outcomes were stable in the long term. Persistent complaints were often caused by other untreated conditions.
BACKGROUND:Patients with exercise-induced lower leg pain may suffer from deep posterior chronic exertional compartment syndrome (dp-CECS). Current evidence for the efficacy of surgery is based on retrospective studies. Effects of fasciotomy on symptoms associated with dp-CECS have not been systematically studied, and reasons for unsuccessful surgery are unknown. PURPOSE: To report the short- and long-term effects of fasciotomy on pain, tightness, and cramps in a prospective cohort of patients with isolated dp-CECS. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between September 2011 and January 2015, pain, tightness, cramps, muscle weakness, and diminished sensation were scored (5-item verbal rating scale ranging from very severe [5 points] to absent [1 point]) in patients with dp-CECS before and after fasciotomy. Outcomes were graded as excellent, good, moderate, fair, or poor. Fair and poor cases were again analyzed during a follow-up visit in the outpatient department. RESULTS: Forty-four patients underwent surgery for isolated dp-CECS. Short-term follow-up (median, 4 months; range, 3-7 months) was complete in 42 of the 44 patients (95%; median patient age, 23 years; 23 male; 64 operated legs). Long-term follow-up (median, 27 months; range, 12-42 months) was complete in 34 of 37 eligible patients (92%). Before surgery, exertional pain was very severe (27%) or severe (61%). Fasciotomy improved all symptoms, both in the short term (preoperative vs postoperative pain, 4.1 ± 0.6 vs 2.3 ± 1.1; P < .001) and the long term (pain, 4.2 ± 0.6 vs 2.7 ± 1.3; P < .001). Levels of tightness, cramps, muscle weakness, and diminished sensation demonstrated similar significant improvements. Short- and long-term symptom scores did not differ. The short-term outcome was excellent in 29%, good in 29%, moderate in 21%, fair in 12%, and poor in 10% of patients. In the long term, outcomes were similar (excellent, 12%; good, 35%; moderate, 24%; fair, 18%; and poor, 12%). An unsatisfactory outcome (fair or poor) was often caused by alternative types of CECS (eg, anterior or lateral CECS) or to medial tibial stress syndrome. Based on their outcome, 76% of patients would opt for surgery again. CONCLUSION: Fasciotomy was beneficial in 71% of patients with dp-CECS in the lower leg; 47% of study patients experienced a good to excellent outcome. Outcomes were stable in the long term. Persistent complaints were often caused by other untreated conditions.
Authors: Johan A de Bruijn; Aniek P M van Zantvoort; Michiel B Winkes; Marike van der Cruijsen-Raaijmakers; Adwin R Hoogeveen; Joep A W Teijink; Marc R M Scheltinga Journal: Orthop J Sports Med Date: 2018-03-02
Authors: Aniek P M van Zantvoort; Johan A de Bruijn; Michiel B Winkes; Adwin R Hoogeveen; Joep A W Teijink; Marc R Scheltinga Journal: Orthop J Sports Med Date: 2017-06-09
Authors: Dai Sugimoto; Anna N Brilliant; Duncan A d'Hemecourt; Charles A d'Hemecourt; Jennifer M Morse; Pierre A d'Hemecourt Journal: J Phys Ther Sci Date: 2018-08-07
Authors: Antonia P M van Zantvoort; Henricus P H Hundscheid; Johan A de Bruijn; Adwin R Hoogeveen; Joep A W Teijink; Marc R M Scheltinga Journal: Orthop J Sports Med Date: 2019-12-24