Summary

Description of a simplified approach to multicompartment leg exertional compartment syndrome

Abstract

A large number of patients with Exertional Compartment Syndrome have both the anterior and deep posterior compartments involved. Since 2000 we have been using a single incision technique which allows for the release of the deep posterior superficial posterior and anterior compartments. This approach allows the medial tibial periosteum to be stripped to treat associated periostalgia. It also gives easy access to the deep posterior compartment and has some advantages in regards to wound healing and recovery.

Between January 2006 and December 2012, a total of 152 patients were treated with this technique. We were able to follow up with questionnaires on 109 of these patients (72% response rate). All patients had confirmed Exertional Compartment Syndrome on intracompartment pressure testing using the Pedowitz criteria.

A questionnaire was completed a minimum of 34 months following the surgery. Of the 109 patients assessed, the mean age at the time of surgery was 24.4 years. A majority of cases were bilateral and patients came from a range of sports and sporting levels. All patients pre-operatively described pain and/or tightness during exercise, 53% also described transient neurologic symptoms that occured with exercise and 25% described incoordination symptoms.

Results

Pain and exercise levels pre-operatively were significantly improved on the visual analogue scales post-operatively. (8.5 pre-op to 2.81 post-op). 89%of patients returned to their desired level of sport.There was no statistical difference between high performance athletes and non high performance athletes when pre and post operative scores were analysed. Complication rates were low and only two patients required subsequent release of the peroneal compartments which were not released at the index procedure.

The single incision technique allows excellent visualisation of three of the four leg compartments and also allows for debridement of the medial tibial periosteum which often causes associated pain when patients have exertional compartment syndrome. We believe our results justify the use of this technique.