Ultrasound-Guided Fasciotomies of the Deep and Superficial Posterior Leg Compartments for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation.

BACKGROUND Chronic exertional compartment syndrome (CECS) is a type of leg pain related to elevated intracompartmental pressure with activity in one or more of the four compartments of the leg.1-3 Open fasciotomy is the definitive treatment for CECS but has a reported complication rate of up to 15.7% and return to full activity reported up to 16 weeks.1, 3-6 Ultrasound-guided (USG) fasciotomy of the anterior and lateral compartment has been translated into clinical practice.7, 8 OBJECTIVE: To determine the safety and feasibility of an USG fasciotomy of the deep posterior compartment (DPC) and superficial compartment (SPC) of the leg in a fresh-frozen cadaveric model. DESIGN Prospective, cadaveric laboratory investigation. SETTING Procedural skills laboratory at an academic institution. CADAVERIC COHORT Ten fresh-frozen cadaveric knee-ankle-foot specimens from 5 female and 5 male donors aged 58-93 years (mean 77.4 years) with body mass indices of 18.1-33.5 kg/m2 (mean 25.1 kg/m2 ). METHODS OR INTERVENTIONS One experienced operator performed ten USG DPC and SPC fasciotomies. A clinical anatomist performed dissections of each. MAIN OUTCOME MEASURES Achievement of target length and continuity of release were recorded. A target length of 10 cm for the superficial posterior compartment (SPC) and 15 cm for the deep posterior compartment (DPC) was established based on previous studies.2, 3 Tendinous and neurovascular structures were assessed for damage. RESULTS No tendon or neurovascular injuries were observed. In the SPC, target length was achieved in 90% and continuous release was observed in 80%. In the DPC, target length was achieved in 60% and continuity observed in 30%. CONCLUSIONS These findings suggest that SPC USG fasciotomies using the technique described in this study are feasible, may be safe, and warrant further translational research; however, DPC USG fasciotomies are more challenging and require more technical refinement prior to clinical translation. LEVEL OF EVIDENCE IV This article is protected by copyright. All rights reserved.