SLR - April 2017 - Lara Kozin
Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients
Reference: Beck JJ, Tepolt FA, Miller PE, Micheli LJ, Kocher MS. Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients. Am J Sports Med. 2016 Oct: 44(10)2644–2650
Scientific Literature Review
Reviewed By: Lara Kozin, DPM
Residency Program: Hoboken University Medical Center
Podiatric Relevance: Chronic exertional compartment syndrome is an issue that is prevalent in our society with the growing active population, both in pediatrics and adults. It is often both overlooked and underdiagnosed. Chronic exertional compartment syndrome is commonly seen in the lower extremity of athletes and in an active young population. These patients experience leg pain and weakness that often prohibit them from engaging in physical activity. Prior studies have shown diagnostic criteria and treatments for adults; however, this study focuses on the surgical treatments and outcomes in a pediatric population.
Methods: This is a retrospective case series of surgical outcomes of operatively treated chronic exertional compartment syndrome in the pediatric population at one institution. This study was performed over a 19-year period from 1995 to 2014 by six surgeons at Boston Children’s Hospital. Inclusion criteria consisted of patients 18 years or younger with chronic exertional compartment syndrome who underwent surgical fascial release. Primary outcome measures include patient and compartment characteristics, such as age, sex, symptoms, duration, primary sport, months from presentation to surgery and procedure types.
Results: The results of this study show that out of 250 legs in 135 patients, the average age of presentation was 16.4 +-1.38 years. Eighty-eight percent of the study population was female. Bilateral symptoms were present in 85 percent of patients, and 84 percent of patients reported symptoms lasting longer than six months. The most common symptomatic activity was running, followed by soccer and field hockey. The average time to surgery was five months, and out of the 250 procedures performed, 47 (18.8 percent) required reoperation. The patients who underwent anterior and lateral releases alone had a higher reoperation rate than those who underwent initial release of all four compartments. The independent predictors of recurrence included the duration of time between presentation and first surgical treatment and which compartments were involved. This study showed that the longer the time between presentation and surgical intervention, the lower the chance of recurrence. Wound complications were noted in 28 of 250 legs (11.2 percent), and all resolved with conservative management. Superficial posterior releases were the most likely to develop infection/dehiscence.
Conclusions: The authors conclude that the majority of the pediatric population with chronic exertional compartment syndrome were female runners, typically around the age of 16 years old who had symptoms persisting for longer than six months. The reoperation rate was more common in patients who only had the anterior and lateral compartments released versus all four, as well as in patients where there was a shorter amount of time from presentation to surgical intervention. Overall, this article emphasizes the importance of properly diagnosing and treating athletes in the pediatric population with chronic exertional compartment syndrome. However, additional studies involving longer follow-up and patient-reported outcome measures are necessary for the further understanding of this type of pathology.