Chronic exertional compartment syndrome prevalent in the military population

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1. Chronic exertional compartment syndrome is common in the military population.

2. Treatment with elective fasciotomy of the leg leads to high rates of symptom recurrence, surgical complications, and disability-associated military discharge.

Evidence Rating Level: 4 (Low)

Study Rundown: Chronic exertional compartment syndrome is an important source of disability for military personnel, as well as high level athletes.  Prior reports of surgical treatment for chronic exertional compartment syndrome in the civilian population have shown favorable results. However, this study suggests that nearly half of the patients evaluated experienced incomplete relief with varying degrees of symptom recurrence after initial postoperative recovery.

This study represents the largest known cohort with chronic exertional compartment syndrome of the leg, and provides valuable information on the outcomes after elective fasciotomy in a physically active patient population.  Much of the data used for this study relied heavily on surgeon reported outcomes, and clinical information available on the electronic medical records.  Additionally, multiple orthopedic providers were involved, and there were no formal standardized operative indications, surgical techniques, or rehabilitation protocols.

Click to read the study in The Journal of Bone & Joint Surgery

Relevant Reading: Diagnosis and management of chronic compartment syndromes: a review of the literature. 

In-Depth [clinical series]: A total of 611 patients underwent 754 elective fasciotomies for chronic exertional compartment syndrome during the study period.  The average patient age was 28.0 years, and 91.8% of the patients were male. Of the surgical procedures, 77.4% were combined anterior and lateral compartment releases only, 19.4% were performed on all four compartments, 2.2% involved only the posterior (i.e., superficial and deep) compartments only, 0.9% involved the lateral compartment only, and 0.13% involved the anterior compartment only.

Symptoms recurred after the fasciotomy in 44.7% of the patients, and 27.8% of the patients were unable to return to full activity. 5.9% of patients underwent revision surgery after an unsuccessful initial fasciotomy, and seven of these patients required bilateral revision surgery.  The cumulative surgical failure rate was calculated to be 21.8%.  Complications occurred in 15.7% of patients, usually involving wound infection, neurological complication, or wound dehiscence.

By JG and AH

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