A systematic review of fasciotomy in chronic exertional compartment syndrome

Background Chronic exertional compartment syndrome (CECS) is an overuse injury typically seen in young and athletic patients. The five cardinal symptoms are pain, tightness, cramping, weakness and paraesthesia. These classically occur during exertion and disappear with cessation of the activity, with no permanent damage to tissues within the compartment; nonetheless, CECS presents a significant functional impairment to those affected. Regulating exercise has been shown to alleviate symptoms but this may not be acceptable to some patients e.g. professional athletes. For patients that fail to respond to conservative management or where exercise reduction is unrealistic, fasciotomy can be considered. There are no established guidelines on the management of CECS, and it remains underdiagnosed. The aim of this systematic review is to compare the outcomes in patients suffering from CECS managed with either fasciotomy or non-operative means by examining functional outcomes and resolution of symptoms. Methods MEDLINE, Embase databases and clinical trial registries were searched comprehensively. 219 articles were identified and 14 articles were included in the systematic review. Given the heterogeneity between the studies in terms of outcomes reported, a qualitative synthesis was performed. Results The majority of included studies were retrospective cohort studies, with a single prospective cohort study. Studies included fasciotomies performed in the upper and lower limbs. Patient population included military servicemen, motocross racers and unselected patients. There is insufficient evidence in the literature to support conservative or surgical management over the other in the management of CECS. However, fasciotomy appears to be a safe approach with satisfaction rates of 48-94%. Complications related to the fasciotomy included haematomas (2.7- 22.5%), nerve injuries (2.0 -18.6%), DVT (2.7%) and symptom recurrence (0.65- 8.4%). Up to 10.4% patients required revision fasciotomy. Conclusion There is no consensus on the optimal management of CECS and as of yet, no established international guidelines on treatment. This systematic review suggests that fasciotomy could a be a safe and viable option in the management of patients suffering from CECS with promising long-term results. Future research in the form of randomised controlled trials comparing conservative and surgical management would be beneficial