Predictors of Improvement After Fasciotomy for Treatment of Chronic Exertional Compartment Syndrome of the Lower Extremity. (July 2021)

• Record Type: Journal Article
• Authors: Mangan, John J.; Rogero, Ryan G.; Fuchs, Daniel J.; Raikin, Steven M.
• Is Part Of: Sports health. Volume 13:Number 4(2021)
• Page Start: 396
• Page End: 401
• Publication Date: 2021-07
• Subjects: chronic exertional compartment syndrome (CECS) -- operative -- patient outcomes -- Foot and Ankle Ability Measure (FAAM) -- visual analog scale (VAS); Sports medicine -- Periodicals; Athletic Injuries -- Periodicals; Physical Education and Training -- Periodicals; Musculoskeletal Physiological Phenomena -- Periodicals; Médecine du sport -- Périodiques; 617.1027
• DOI: 10.1177/1941738120984109
• Languages: English
• ISSNs: 1941-7381

Abstract

Background: Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating chronic exertional compartment syndrome (CECS). However, not all patients have demonstrated the same level of symptom improvement. Hypothesis: Specific patient variables will lead to enhanced functional improvement after fasciotomy for CECS of the lower extremity. Study Design: Case series. Level of Evidence: Level 4. Methods: A review of patients undergoing fasciotomy of the lower extremity for treatment of CECS by a single surgeon from 2009 to 2017 was performed. Pre- and postoperative measures of Foot and Ankle Ability Measure–Sports subscale (FAAM–Sports), FAAM–Sports Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected at a minimum of 12 months postoperatively. The primary outcomes of change in FAAM-Sports, FAAM-Sports SANE, and VAS during sporting activities were calculated by taking the difference of post- and preoperative scores. Generalized multiple linear regression analyses was performed to determine independent predictors of functional and pain improvement. Results: A total of 61 patients (58% response rate) who underwent 65 procedures were included in this study, with postoperative outcome measures obtained at mean duration of 57.9 months (range, 12-115 months) after surgery. Patients had a mean ± SD improvement in FAAM-Sports of 40.4 ± 22.3 points ( P < 0.001), improvement in FAAM-Sports SANE of 57.3 ± 31.6 points ( P < 0.001), and reduction of VAS pain of 56.4 ± 31.8 points ( P < 0.001). Multiple linear regression analysis revealed deep posterior compartment involvement, younger age, a history of depression, and male sex to be significant independent predictors of enhanced improvement after fasciotomy. Conclusion: Fasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater functional improvement. Clinical Relevance: Male patients, younger patients, patients with depression, and patients with deep posterior compartment involvement may serve to benefit more with fasciotomies for treatment of CECS.