Surgical Treatment for Chronic Lower Leg Compartment Syndrome in Young Female Athletes

abstract & commentary

Synopsis: Teenage female athletes are more susceptible to chronic lower extremity compartment syndromes than are men. Females seem to respond less well to surgical decompression.

Source: Micheli LJ, et al. Surgical treatment for chronic lower-leg compartment syndrome in young femal athletes. Am J Sports Med 1999; 27(2):197-201.

Micheli has a long-standing interest in the treatment of chronic lower extremity compartment syndromes and, between 1980 and 1997, he performed fasciotomies on 53 teenage female athletes with chronic, lower leg compartment syndrome. Despite a typical balance between the sexes with regard to sports-related injuries in his clinic, a much smaller number of male teenage athletes eventually underwent surgery for the same problem. This review presents the results of the fasciotomies for chronic compartment syndrome in this group of young female athletes.

Forty-seven of the 53 patients were seen in follow-up at an average of 4.2 years after surgical treatment. The mean age of the patients at the time of treatment was slightly more than 17 years. Virtually all were involved in varsity athletics at the high school or college level. The diagnosis of compartment syndrome was based upon clinical symptoms and confirmed by persistently elevated intracompartmental pressures after exercise in every case. The affected compartments were surgically decompressed using small skin incisions and subcutaneous release of the fascia with a Smellie knife.

A total of 103 compartments underwent decompression (70% anterior, 18% lateral, 10% deep posterior, and 2% superficial posterior). Anterior compartment decompression was successful in almost 90% of cases, while decompression of one or more of the other compartments had less successful overall results. Indeed, eight patients denied having any benefit from the surgical decompression. Micheli and colleagues conclude that teenage female athletes are perhaps more susceptible to chronic lower extremity compartment syndromes than are men. They also identify the fact, in this study as well as others, that females seem to respond less well to surgical decompression.

Comment by James D. Heckman, MD

This is an interesting retrospective review of a large sports medicine practice in a children’s hospital. Micheli et al identify some changing trends as the level of suspicion for the diagnosis of compartment syndrome increases. Between 1980 and 1989, Micheli only performed eight fasciotomies, but between 1990 and 1997 he treated 45 patients for the same problem. A high proportion of his surgical patients were women, and the percentage of women with this problem seems to have increased fairly dramatically over the last decade or so. Concurrent with the increased problems in women has been a decline in the overall success rate of fasciotomy for chronic compartment syndrome. Other authors also have found a higher success rate in treating men than in treating women with this problem.1

Micheli had 10 patients who did extremely well aftesur the surgery and it probably would be beneficial for him to go back and define the clinical and physical findings in this group of ten patients because that might give us a clearer idea of what the right indications would be for surgical decompression. As with any emerging concept, the frequency of diagnosis increases rapidly once the information becomes available. We perhaps are experiencing a peak of the curve in which too many diagnoses of chronic compartment syndrome, particularly in females, have been made. We now need to back off a little bit and become more rigorous in the specific definition of this condition and more selective in our surgical cases so that fasciotomy will be successful in an extremely high percentage of patients in the future.

Reference

1. Schepsis AA, et al. Surgical management of exertion compartment syndromes of the lower leg. Am J Sports Med 1993;21:811-817.