Intermediate Duration Outcomes of Surgical Management for Chronic Exertional Compartment Syndrome in Adolescents and Young Adults: The Mubarak Fasciotome.

Abstract

Objective: Chronic exertional compartment syndrome (CECS) poses challenges in diagnosis and management, particularly in young athlete populations. Current surgical approaches have been successful after failed conservative management, but with only short-term follow-up detailed in the literature. This study aimed to evaluate intermediate outcomes (>2 y) of surgical management for CECS in adolescents and young adults using the Mubarak fasciotome, with attention to complications and patient-reported outcomes.

Methods: A retrospective review of patients identified over a 13-year period who underwent lower extremity fasciotomy was performed. Those with CECS were included based on the history of lower extremity symptoms and elevated intracompartmental pressure readings meeting Pedowitz criteria. Fasciotomy was performed with the Mubarak fasciotome under general anesthesia. Single-incision approaches were used for anterior/lateral compartments, and/or a medial incision for posterior compartments. Patients received postoperative therapy and underwent patient-reported outcomes assessment, including MARX and SANE scores, and pain ratings at various time points and final follow-up. Descriptive statistics were calculated using SPSS.

Results: We identified 6 patients (10 limbs) undergoing fasciotomy for CECS with a mean follow-up of 7.2 years (range: 2 to 12.5 years). Following surgery, patients reported significant improvements in pain, with mean scores decreasing from 7.7 to 1.5. MARX scores indicated a return to high physical activity, with a mean of 8.7. SANE scores for activities of daily living and athletics were high, indicating functional recovery. Yet only 66% of patients returned to their original sport or a comparable activity level. No major complications were noted.

Conclusion: The Mubarak fasciotome for CECS surgery in adolescents and young adults resulted in favorable intermediate outcomes that persist throughout the athlete's career, including pain reduction, functional improvement, and high satisfaction. This minimally invasive technique offers a promising alternative to traditional fasciotomy when careful attention is placed on fasciotome placement to avoid nerve injury.