Diagnosis and management of chronic exertional compartment syndrome of the leg: An evidence-based approach

Chronic Exertional Compartment Syndrome (CECS) is a condition causing leg pain during exercise. It affects both civilians and military personnel, impacting their quality of life and military readiness. CECS arises from increased pressure within muscle compartments during exercise, with unclear causes. It commonly affects runners, football players, and military members. This thesis aims to enhance evidence-based medicine for CECS in both civilian and military contexts. The study identifies differences in diagnosis and treatment between these populations.

The diagnosis and treatment of CECS lack standardized protocols. A Delphi study involving experts established five key criteria for CECS diagnosis. Alternative diagnostic tests like MRI, NIRS, and SPECT show promise but require further research. Invasive Intracompartmental Pressure (ICP) measurements, while commonly used, lack standardized protocols. The study suggests a single-leg ICP measurement can be sufficient for military patients with specific cutoff values.

Treatment strategies for CECS vary. Surgical intervention generally yields higher satisfaction and return to activity rates compared to conservative methods. However, in military populations, surgical treatment can lead to more complications. Conservative treatments, especially for military patients, are recommended first. Recurrent cases may require fasciotomy or fasciectomy.

In conclusion, CECS diagnosis and management lack standardized guidelines. Civilian and military populations exhibit significant differences in symptoms and treatment outcomes. ICP measurements should be used judiciously, with consideration for patient population and specific cutoff values. The choice between conservative and surgical treatment depends on patient characteristics. Further research is needed to refine diagnostic methods and treatment protocols for CECS.