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

Details

Supervisors

Nguyen, Anh Phong

Faculty

Faculté des sciences de la motricité

Degree label

Master [120] en sciences de la motricité, orientation générale, à finalité spécialisée: kinésithérapie musculo-squelettique

Abstract

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 of PubMed, Embase and Scopus from 1990 to 2019 was conducted, following the PRISMA guidelines. After application of the inclusion criteria, 44 studies dealing with different treatment options for CECS were included. The quality of the evidence was measured using an adapted version of the Critical Appraisal Skills Programme (CASP). Results: A total of 1036 original articles were identified. Within the 44 selected articles, 37 deal with surgical fasciotomy or fasciectomy, six use conservative management in form of gait-retraining and physical therapy and one study evaluated the effect of botulinum toxin injections (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. Comparative studies between surgical and conservative treatment demonstrated high risk of selection bias. Overall, literature on treatment of CECS is very heterogenous in terms of both outcomes and population. 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, conservative management in form of gait-retraining should at least be envisioned in patients with post-surgical symptom recurrence. However, further evidence in form of high-quality studies with larger populations is needed regarding this topic.