Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up

Key Points

1. Chronic exertional compartment syndrome (CECS) is common in runners and the military, however to date there is little high quality evidence to guide management.

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BACKGROUND & OBJECTIVE

Chronic exertional compartment syndrome (CECS) is typically exercise-induced pain associated with elevated intra-compartmental pressure. The most common form of this occurs in the anterior compartment of the lower leg where patients often describe anterolateral aching or tightness that subsides once exercise is stopped.

This anterior CECS is frequently seen in military populations and has historically been treated with surgical fasciotomy. However, outcomes from surgery can be inconsistent, with only 34% of patients returning to their original military roles (1). Recent research has also challenged the role of surgery as well as the concept of CECS, suggesting it be seen as a ‘biomechanical overload syndrome’ (2). There is clearly a need for effective, conservative management of anterior CECS, and this study aimed to assess a comprehensive approach by examining data and long-term results from a historic cohort.

The most common form of chronic exertional compartment syndrome occurs in the anterior compartment of the lower leg.

Clinically it may be helpful to think of chronic exertional compartment syndrome as a ‘biomechanical overload’.

METHODS

Medical records were obtained for patients with either a diagnosis of anterior CECS or CECS in conjunction with medial tibial stress syndrome who were treated at a military sports medicine centre between 2015 and 2018. Follow up surveys were carried

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