Fasciotomy for Exertional Anterior Compartment Syndrome
Fasciotomy for Exertional Anterior Compartment Syndrome: Is Lateral Compartment Release Necessary?
Abstract & commentary
Synopsis: There is no advantage to performing a lateral compartment release in patients with an isolated exertional anterior compartment syndrome.
Source: Schepsis AA, et al. Fasciotomy for exertional anterior compartment syndrome: Is lateral compartment release necessary? Am J Sports Med 1999;27:430-435.
This prospective, randomized study was designed to determine if patients with clearly defined exertional anterior compartment syndrome needed to have a lateral compartment release performed at the same time that the anterior compartment was released. All the patients were actively involved in running sports and their average age was 23 years. Symptoms had been present for more than a year, on average, in all the patients. Chronic exertional anterior compartment syndrome was diagnosed in all patients by demonstrating elevated post-exercise intracompartmental pressures. Thirty compartment releases were performed in 20 patients, with 10 being bilateral. In 15 of the affected limbs, a simple anterior compartment release was performed through a 5cm skin incision over the anterior aspect of the leg. In the other 15 patients, both the anterior and lateral compartments underwent fasciotomy through the single incision. The patients were randomized as to treatment group, and in the 10 patients with bilateral symptoms, on one leg an isolated anterior compartment fasciotomy was performed and on the opposite leg both compartments were released.
Clinical criteria were established for the outcome of the decompression. When the two groups of patients were compared, it was found that doing the additional lateral compartment fasciotomy did not result in any better outcome. Furthermore, those patients who had two compartment releases took 11.4 weeks to return fully to their respective athletic activity, whereas the patients who had an isolated anterior compartment fasciotomy were able to return to their sport at an average of 8.1 weeks. Schepsis and colleagues conclude that there is no advantage to performing a lateral compartment release in patients with an isolated exertional anterior compartment syndrome.
Comment by James D. Heckman, MD
This is a well-conducted study that has limited variables and clearly compares the two surgical techniques. Schepsis et al aggressively selected out patients who might have had involvement of the lateral compartment and did not include them in this study. Thus, they were left with a distinct patient population with disease limited to the anterior compartment. The disease was clearly confirmed by measurement of post-exercise intracompartmental pressures preoperatively. The athletes’ ability to return to their respective sports in virtually all cases also shows that this operation is effective in relieving such well-defined symptoms.
Schepsis et al extended the comparative study one step further in the 10 patients with bilaterally symmetrical symptoms. In those patients, they performed an anterior compartment release on one side and combined anterior and lateral compartment releases on the other side. Seven of the 10 patients reported that they recovered more quickly on the side that had only an anterior compartment release.
Limiting the surgical decompression to the area of discretely defined pathology makes a lot of sense. The addition of a lateral compartment release does not seem to be necessary in this well-defined patient population. It does seem to delay recovery, and doing it may unnecessarily extend the risk of surgery.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.