Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest The authors exclude any conflict of interest according the requirements of publishing standards as stated in the ICMJE recommendations. 20. Foot Ankle Int. 2023 Nov;44(11):1097-1104. doi: 10.1177/10711007231192076. Epub 2023 Sep 19. Lower Leg Lateral Chronic Exertional Compartment Syndrome: Prospective Surgical Treatment Outcomes for Isolated or Combined Lateral Fasciotomy. van Zantvoort APM(1)(2), de Bruijn JA(1)(2), Hundscheid HPH(1), Teijink JAW(2)(3), Scheltinga MR(1)(2). Author information: (1)Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands. (2)Caphri Research School, Maastricht University Medical Center, Maastricht, the Netherlands. (3)Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. Comment on J Orthop Surg Res. 2016 May 24;11(1):61. doi: 10.1186/s13018-016-0395-9. BACKGROUND: Chronic exertional compartment syndrome involving the lower leg lateral compartment (lat-CECS) seldom occurs isolated but is usually combined with CECS of the anterior (ant-CECS) or deep posterior compartment (dp-CECS). Patient characteristics in lat-CECS and outcome after surgery are largely unknown. The aim of this prospective case series was to describe patient characteristics and symptoms and to report on outcome following a fasciotomy. METHODS: All patients diagnosed with lat-CECS based on exertional lateral lower leg symptoms and elevated intracompartmental pressure (ICP) measurements according to the Pedowitz criteria (ICP ≥ 15 mm Hg at rest, and/or ≥30 mm Hg after 1 minute, and/or ≥20 mm Hg 5 minutes after exercise) were eligible for this study. A standard intake questionnaire scoring symptom patterns was completed by all patients. Patients who were operated for lat-CECS were asked to complete a 3-month and 12-month postoperative questionnaire scoring symptoms and surgical outcome. Patients with a history of CECS surgery, recent lower leg trauma, or peripheral neurovascular disease were excluded. RESULTS: A total of 881 patients with possible lower leg CECS completed an intake questionnaire and 88 (10%) were diagnosed with lat-CECS according to the Pedowitz criteria (isolated lat-CECS n = 10; lat/ant CECS n = 54, lat/ant/dp CECS n = 19, lat/dp CECS n = 5). Severe pain during exercise and moderate tightness during rest were frequently reported. A group of 28 patients (49 legs; isolated lat-CECS n = 2; lat/ant CECS n = 22, lat/ant/dp CECS n = 3, lat/dp CECS n = 1) was analyzed after fasciotomy. Complications were minor (wound infection requiring antibiotics, n = 3; temporary complex regional pain syndrome with spontaneous recovery, n = 1). Superficial peroneal nerve damage was not observed. One year after surgery, 64% rated outcome as excellent or good, whereas 71% had resumed sports activities. CONCLUSION: One in 10 patients with anterolateral exertional lower leg pain evaluated in a tertiary referral center met diagnostic criteria for lat-CECS. Pain and tightness were present during exertion and were often reported occurring during rest and at night. In this series, we found fasciotomy-either an isolated (lateral) or a multiple (combined with anterior and/or deep posterior) compartment fasciotomy-is safe and beneficial in most patients. LEVEL OF EVIDENCE: Level IV, case series. DOI: 10.1177/10711007231192076