A systematic review of current surgical and conservative treatment in lower limb chronic exertional compartment syndrome. Sports Orthopaedics and Traumatology

Rauschen, Hannah [UCL] arnaud randoux [UCL] Nguyen, Anh Phong [UCL]

Summary Background Chronic exertional compartment syndrome (CECS) is a muscular overuse injury, usually affecting runners, athletes, or military personnel. The present study aims to provide a systematic overview of the surgical and conservative treatment options and their effectiveness in lower limb CECS. Method A systematic literature search following the PRISMA guidelines was conducted. The quality of the evidence was measured using an adapted version of the Critical Appraisal Skills Programme (CASP). Results 44 studies were included. 37 of them deal with surgical fasciotomy or fasciectomy, six used conservative management in form of gait-retraining and physical therapy and one study evaluated the effect of BoNT-injections in the affected compartments. Fifteen studies reported satisfaction rates above 70% in patients treated with fasciotomy. Conservative management showed good, but slightly lower results than surgical treatment. Conclusion Fasciotomy is an effective treatment in most patients suffering from CECS of the lower leg. Results of conservative treatment by gait-retraining and of treatment with BoNT-injections are promising. Specifically, gait-retraining may be considered as treatment of choice in military personnel, as in this population fasciotomy appears to be less effective than in athletes. Meanwhile, in an athlete population, where fasciotomy remains the standard treatment for CECS, gait-retraining should at least be envisioned in patients with post-surgical symptom recurrence.