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Revision Surgery for Exertional Anterior Compartment Syndrome of the Lower Leg

Technique, Findings, and Results

From the Department of Orthopedic Surgery, Boston University Medical Center, Boston, Massachusetts

^* Address correspondence to Anthony A. Schepsis, MD, Boston University Medical Center, 720 Harrison Avenue, No. 808, Boston, MA 02118 (e-mail: anthony.schepsis{at}bmc.org).

Background: Recurrent symptoms or failure after fasciotomy for exertional anterior compartment syndrome is not uncommon.

Hypothesis: Symptoms from high compartment pressures can be secondary to involvement of the entire compartment or to localized constrictions from postsurgical fibrosis, as well as to entrapment of the superficial peroneal nerve.

Study Design: Case series; Level of evidence, 4.

Methods: Eighteen patients who underwent revision surgery for exertional anterior compartment syndrome were available for follow-up. All were athletes who had either a failure or a recurrence of symptoms at a mean of 23.5 months (range, 8–54 months) after the index fasciotomy. Pressure measurements using a slit catheter at rest, at 1 minute postexercise, and at 5 minutes postexercise were performed in 2 places within the compartment: in the area of the previous incision and in the proximal muscle belly of the tibialis anterior. Surgical technique consisted of a 2-incision approach with partial fasciectomy, exploration and decompression of the superficial peroneal nerve, and excision of all fibrotic tissue. An objective examination and a comprehensive subjective questionnaire previously described were performed at a mean follow-up of 42 months (range, 22–67 months).

Results: Sixty percent of patients had abnormal pressures only in a localized area, whereas 40% had high pressures throughout the compartment. Eight of 18 (44%) patients had symptoms, signs, and surgical findings of entrapment of the superficial peroneal nerve. At follow-up, 72% of patients had a satisfactory outcome (5 excellent, 8 good), and 28% had an unsatisfactory outcome for intense running sports (4 fair, 1 poor), although 3 patients with the fair results reported improvement with low-level activity. All 8 patients with documented peroneal nerve entrapment had a satisfactory outcome.

Conclusion: Symptoms from high pressures can be secondary to involvement of the entire compartment or localized to a certain area from postsurgical fibrosis. Pressure measurements should be performed in at least 2 separate areas.

Key Words: compartment syndrome • exertional • failures • revision • surgery