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Scientific Articles   |    
Surgical Treatment of Chronic Exertional Compartment Syndrome of the LegFailure Rates and Postoperative Disability in an Active Patient Population
CPT Brian R. Waterman, MD1; CPT Matthew Laughlin, DO1; CPT Kelly Kilcoyne, MD2; Kenneth L. Cameron, PhD, MPH, ATC3; LTC Brett D. Owens, MD3
1 Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001. E-mail address for B.R. Waterman: brian.r.waterman@us.army.mil
2 Department of Orthopaedics and Rehabilitation, Walter Reed National Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
3 The John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, U.S. Military Academy, 900 Washington Road, West Point, NY 10996
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Investigation performed at the Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas

A commentary by Keith M. Baumgarten, MD, is linked to the online version of this article at jbjs.org.

Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the U.S. government. The authors are employees of the U.S. government.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 03;95(7):592-596. doi: 10.2106/JBJS.L.00481
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Abstract

Background: 

Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population.

Methods: 

Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (Current Procedural Terminology [CPT] codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision [ICD-9] code 729.72) between 2003 and 2010 were identified from the Military Health System Management Analysis and Reporting Tool (M2). Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Army Physical Disability Agency database.

Results: 

A total of 611 patients underwent 754 surgical procedures. The average patient age was 28.0 years, and 91.8% of the patients were male. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases; 19.4% addressed the anterior, lateral, and posterior compartments; and 2.2% addressed the posterior compartments alone. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio [OR], 1.64), perioperative complications (OR, 2.12), activity limitations (OR, 4.41), and persistence of preoperative symptoms (OR, 8.46). Multivariable analysis confirmed significant associations between surgical failure and perioperative complications (OR, 1.72), activity limitations (OR, 2.23), and persistence of preoperative symptoms (OR, 5.47), whereas other factors were not significantly associated with surgical failure.

Conclusions: 

Chronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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