SLR - March 2022 - Parneet Kaur
Reference: de Bruijn JA, van Zantvoort APM, Hundscheid HPH, et al. Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg. OrthopJ Sports Med. 2021 Nov 29;9(11).Level of Evidence: II
Scientific Literature Review
Reviewed By: Parneet Kaur, DPM
Residency Program: Our Lady of Lourdes Memorial Hospital – Binghamton, NY
Podiatric Relevance: Chronic exertional compartment syndrome (CECS) can be overlooked as a cause of muscle pain. A 22-month delay in the diagnosis of the condition has been reported. Studies of the etiology of chronic anterior leg pain indicate that CECS is the causative factor in 27% of cases. The differential diagnoses include Medial Tibial Stress Syndrome (MTSS), stress fracture, fascial defects, nerve entrapment syndromes, popliteal artery entrapment syndrome, and claudication. The delay in diagnosis combined with the relative frequency of occurrence underscores the importance that providers should consider CECS as a possible diagnosis that may affect an individual’s participation in sports or physical activity and be prepared with an operative plan for decompression.
Methods: Patients included in this study underwent fasciotomy with a novel operative device (FascioMax fasciotome) in one leg and fasciotomy with a widely accepted device (Due fasciotome) in the contralateral leg during a single operative session. Included were patients aged 18 years or older who had planned operative treatment of bilateral ant-CECS. Enrollment of patients was between October 1, 2013, and April 12, 2018. Of the 245 patients who were diagnosed with CECS, 52 were included. Outcomes assessed included postoperative pain, peri- and post-operative complications, and symptom reduction at 3 to 6 months and >1 year. The ability to return to sport was also assessed. Primary outcome assessed was a reduction in the 5 cardinal symptoms associated with CECS (pain, tightness, muscle weakness, cramps, and altered sensation). Secondary outcome measurements were intraoperative complications (substantial bleeding, incomplete fasciotomy), postoperative pain, postoperative complications, and ability to regain exercise.
Results: Primary outcome was a reduction in the 5 cardinal symptoms associated with CECS. To compare overall improvement, individual symptom scores were summed for an overall CECS symptom score (range, 0-104 points). Refer to the article for the scoring shown in Table 1. The study reports similar results for both groups for secondary outcomes. Postoperative pain was similar in both groups for the first two weeks. Total postoperative wound pain and leg pain, deep anterolateral leg pain and superficial wound pain were virtually absent of the legs operated with the FascioMax. In legs operated with the Due fasciotome, these numbers were comparable. Between 3 and 6 months, 82% of the patients (41/50) had returned to the sport they participated in prior to CECS- associated symptoms started. At long-term follow-up beyond 1 year, 82% of the patients were able to participate in their favorite sport, 8% were forced to start a new sport, and 10% were not able to restart sports. Two-thirds (67%) of the patients were able to exercise at a level that was comparable with or higher than before the debilitating CECS symptoms emerged. Both fasciotomies resulted in the ability to again practice the desired type of sport in 82% of the patients. However, one-third of the patients were forced to exercise at a lower than desired level or decided to shift to another type of sport. The ongoing presence of untreated additional exercise-induced syndromes such as MTSS or CECS of other leg compartments likely contributes to this percentage.
Conclusions: This study assesses changes of intensity and frequency of all five symptoms associated with CECS. This approach enabled them to compose a symptom score and a combined symptom score, allowing for comparison of the effect of both devices. The FascioMax and the Due fasciotome reduced CECS-associated symptoms in a similar way, indicating that both devices are effective for patients with ant-CECS.