Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery

Abstract

Aim: To evaluate whether surgical treatment for anterior chronic exertional compartment syndrome (CECS) of the lower leg will lead to full athletic activity recovery compared to conservative treatment. Methods: Patients diagnosed with anterior CECS of the leg were offered surgical treatment, as surgery considered today to be the mainstay of treatment. Patients unwilling to be treated surgically were treated conservatively. They were followed up, assessing both groups for pain, functional status, and the Tegner sports activity score with comparisons at diagnosis and following treatment. Results: Forty-three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16–54.09) months. Reported pain improved at follow-up by 1.59 (0–6) points and by 4.27 ± (0–10) points in the conservatively and the surgically treated patient groups, respectively ( p = 0.014) with a mean change in the Tegner score of 0.09 (−5 to 5) and 3.22 (−4 to 7), respectively ( p = 0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level ( p = 0.001). Conclusion: This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity.