Abstract
Objectives:
Operative treatment of Chronic Exertional Compartment Syndrome (CECS) with fasciotomy has been shown to be effective in symptomatic resolution of CECS, but outcomes at long term follow-up are not well understood. The purpose of this study is to present the long-term outcomes for CECS patients treated with fasciotomy.
Methods:
We conducted a retrospective review of patients who underwent fasciotomy of one or more compartments for treatment of CECS at our institution from 2010 to 2021. Outcomes were assessed using the Tegner Activity Scale, symptom resolution, patient satisfaction, return to sports (RTS) and the EuroQol (EQ-5D-5L) survey. Statistical analysis was completed using SPSS, Version 24 (IBM Corp., Armonk, NY). Normally distributed continuous variables between cohorts were compared using the two-sample Student t-test.
Results:
Thirty-four patients, 16 males and 18 females, who underwent open fasciotomy for CECS were included. Mean age at the time of surgery was 29.6 ±12.7 years and mean follow-up was 6.1 ±2.2 years (range 2.5-10.3). Tegner activity level scores at final follow up were significantly higher compared to scores at symptom onset (mean: 4.8 vs. 3.3, p<0.001). Regression analyses showed EQ-5D-5L scores were significantly associated with a post-operative diagnosis of popliteal artery entrapment syndrome (β=-0.135, p=0.023) and increased pre-operative symptom duration (β=-0.0003, p=0.043). 28/34 (82.3%) reported improved symptoms following fasciotomy, 5 (14.7%) reported no change, and 1 (2.9%) had worsened symptoms. Of those with improved symptoms, 19/28 (67.9%) reported complete symptom resolution. Twenty-six (76.5%) patients returned to sport and of these patients, 18/26 (69.2%) returned to their preinjury level. The average time to return to sport was 23.4±27.4 months. Of the 20 patients who worked prior to surgery, 18 (90.0%) returned to their pre-injury level and average time to return to work was 6.5±12.5 months. Twenty-four (70.6%) patients would be willing to have their fasciotomy again and average VAS satisfaction rate was 78.1.
Conclusions:
Pre-operative symptom duration and post-operative diagnosis of popliteal artery entrapment syndrome were poor prognostic indicators for patients diagnosed with CECS following fasciotomy at long term follow up. Tegner scores significantly improved at final follow up and the majority of patients returned to sport and work.