Background: Exercise Induced Compartment Syndrome (EICS) is a rare source of pain in athletes that can significantly limit their ability to compete and train. It can also curtail participation of non-competitive athletes who desire to continue a recreation program for fitness, health, or enjoyment. Open fasciotomy remains the primary surgical treatment for EICS, which is often refractory to conservative management, despite mixed evidence of the procedure’s efficacy. We evaluated a series of patients undergoing open fasciotomy for EICS of the leg in our institution to assess postoperative outcomes. Methods and Findings: A retrospective review of patients undergoing open fasciotomy for EICS by a single surgeon in a high volume orthopaedic practice was conducted. Twenty-five patients were followed for an average of 3.26 ± 1.50 years postoperatively. Patients had an average age of 29.96 ± 14.33 years, BMI of 27.86 ± 5.17 m/kg2, and were 80% female. Sixteen patients underwent bilateral fasciotomies (64%), with 4 patients (16%) receiving two compartment and 21 (84%) receiving four compartment release. A significant reduction in intra-compartmental pressure, as measured intra-operatively pre and post fasciotomy by hand-held manometry (Stryker), was observed in all treated compartments. Average resting pressure decreases ranged from 15.09 mmHg in the anterior compartment to 10.4 mmHg in the deep posterior compartment (all p<.001). Surgical success, defined as the absence of revision surgery within the study time period, was achieved in 19 patients (76.0%). Of the 6 patients requiring return to the operating room (OR), 3 were for evacuation of hematoma and 3 were for revision fasciotomy for recurrent symptoms. Postoperative wound complications, defined as hematoma or cellulitis requiring antibiotics, occurred in 6 patients (24.0%). Twenty-four of 25 patients (96.0%) achieved confirmed return to function (sport, work or activities of daily living) within the study period. Conclusion: Our case series confirms the efficacy of open fasciotomy for the treatment of exercise induced compartment syndrome. Surgery resulted in significant decreases in compartment pressures, and 96% of patients achieved an adequate level of postoperative function. However, cellulitis or postoperative hematomas occurred in 24% of patients, and 24% of patients required return to the OR, three for revision fasciotomy and three for evacuation of hematoma. Patients should be followed closely after fasciotomy, and further research is necessary to help define better surgical techniques and rehabilitation to decrease postoperative complications.
Justin Turcotte*, Natalia Gonzales, and Christina Morganti