3 research outputs found
Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg
Objective: Surgery is the gold standard in the management of chronic exertional compartment syndrome (CECS) of the lower extremity, although recent studies also reported success following gait retraining. Outcome parameters are diverse, and reporting is not standardized. The aim of this systematic review was to analyze the current evidence regarding treatment outcome of CECS in the lower leg. Material and Methods: A literature search and systematic analysis were performed according to the PRISMA criteria. Studies reporting on outcome following treatment of lower leg CECS were included. Results: A total of 68 reports fulfilled study criteria (n =; 3783; age range 12-70 year; 7:4 male-to-female ratio). Conservative interventions such as gait retraining (n =; 2) and botulinum injection (n =; 1) decreased ICP ((Formula presented.) =; 68 mm Hg to (Formula presented.) =; 32 mm Hg) and resulted in a 47% (±42%) rate of satisfaction and a 50% (±45%) rate of return to physical activity. Fasciotomy significantly decreased ICP ((Formula presented.) =; 76 mm Hg to (Formula presented.) =; 24 mm Hg) and was associated with an 85% (±13%) rate of satisfaction and an 80% (±17%) rate of return to activity. Return to activity was significantly more often achieved (P <.01) in surgically treated patients, except in one study favoring gait retraining in army personnel. Conclusion: Surgical treatment of CECS in the lower leg results in higher rates of satisfaction and return to activity, compared to conservative treatment. However, the number of studies is limited and the level of evidence is low. Randomized controlled trials with multiple treatment arms and standardized outcome parameters are needed
Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry
Introduction Despite guideline recommendations
advocating conservative management before
invasive treatment in intermittent claudication, early
revascularisation remains widespread in patients with
favourable anatomy. The aim of the Effect of Disease
Level on Outcomes of Supervised Exercise in Intermittent
Claudication Registry is to determine the effect of the
location of stenosis on the outcomes of supervised
exercise in patients with intermittent claudication due to
peripheral arterial disease.
Methods and analysis This multicentre prospective
cohort study aims to enrol 320 patients in 10 vascular
centres across the Netherlands. All patients diagnosed
with intermittent claudication (peripheral arterial disease:
Fontaine II/Rutherford 1–3), who are considered candidates
for supervised exercise therapy by their own physicians
are appropriate to participate. Participants will receive
standard care, meaning supervised exercise therapy first,
with endovascular or open revascularisation in case of
insufficient effect (at the discretion of patient a
Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy
The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen