Management of chronic exertional anterior compartment syndrome of the lower extremity

Eighteen patients (28 compartments) with chronic exertional compartment syndrome and 14 normal asymptomatic volunteers (18 compartments) were studied. Evaluation included clinical assessment followed by quantitative determination of intracompartmental pressures as monitored by wick or slit catheters before and after exercise. Intramuscular pressures measuring greater than or equal to 10 mmHg at rest and/or greater than or equal to 25 mmHg five minutes after exercise were defined as abnormally elevated. The patients with chronic compartment syndrome described reproducible exertional anterolateral leg pain, and 39% of these patients had a fascial hernia. Such a defect was present in less than five percent of the normal volunteers. Nonsurgical treatment was selected by five patients and all five reported persistent inability to participate in athletics because of their exertional pain. Of the remaining 13 patients, 12 were treated by decompressive fasciotomy and 11 of the 12 (92%) had pain relief and increased exercise tolerance. A single patient had had fascial closure instead of fasciotomy, and this procedure produced an acute compartment syndrome. Effective treatment of the chronic compartment syndrome consists of reduction of exertional activities or surgical decompression by fasciotomy.