Int J Sports Med 2021; 42(11): 1027-1034
DOI: 10.1055/a-1342-8209
Orthopedics & Biomechanics

A Comparison of Two Models Predicting the Presence of Chronic Exertional Compartment Syndrome

Emeline Vignaud
1   Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes, France
2   Rhumatologie, CHU Nantes, Nantes, France
,
Pierre Menu
1   Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes, France
3   Médecine du Sport, CHU Nantes, Nantes, France
4   Inserm U1229, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
,
Yannick Eude
5   Santé Publique, CHU Nantes, Nantes, France
,
Yves Maugars
2   Rhumatologie, CHU Nantes, Nantes, France
4   Inserm U1229, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
,
Marc Dauty
1   Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes, France
3   Médecine du Sport, CHU Nantes, Nantes, France
4   Inserm U1229, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
6   Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
,
Alban Fouasson-Chailloux
1   Service de Médecine Physique et Réadaption Locomotrice, CHU Nantes, Nantes, France
3   Médecine du Sport, CHU Nantes, Nantes, France
4   Inserm U1229, Regenerative Medicine and Skeleton, Université de Nantes, Nantes, France
6   Institut Régional de Médecine du Sport, CHU Nantes, Nantes, France
› Author Affiliations

Abstract

Clinical history and physical examination are usually not sufficient to diagnose leg chronic exertional compartment syndrome (CECS). Two predictive clinical models have been proposed. The first model by De Bruijn et al. is displayed as a nomogram that predicts the probability of CECS according to a risk score. The second model by Fouasson-Chailloux et al. combines two signs (post-effort muscle hardness on palpation or hernia). To evaluate those models, we performed a prospective study on patients who were referred for possible CECS. 201 patients underwent intra-compartmental pressure at 1-min post-exercise (CECS if ≥ 30 mmHg) – 115 had CECS. For the De Bruijn et al. model, the risk score was 7.5±2.2 in the CECS group and 4.6±1.7 in the non-CECS group (p<0.001) with an area under the ROC curve of 0.85. The model accuracy was 80% with a sensitivity of 82% and a specificity of 78%. Concerning Fouasson-Chailloux et al. model, the accuracy was 86%; the sensitivity and the specificity were 75 and 98%, respectively. The De Bruijn et al. model was a good collective model but less efficient in individual application. In patients having both muscle hardness and hernia, we could clinically make the diagnosis of CECS.



Publication History

Received: 05 November 2020

Accepted: 10 December 2020

Article published online:
13 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom. Clin J Sport Med 2006; 16: 209-213
  • 2 Baltopoulos P, Papadakou E, Tsironi M. et al. Pre, during, and post exercise anterior tibial compartment pressures in long distance runners. J Sports Sci Med 2008; 7: 96-100
  • 3 Dunn JC, Waterman BR. Chronic exertional compartment syndrome of the leg in the military. Clin Sports Med 2014; 33: 693-705
  • 4 Edwards PH, Wright ML, Hartman JF. A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med 2005; 33: 1241-1249
  • 5 Abraham P, Leftheriotis G, Saumet JL. Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome. J Bone Joint Surg Br 1998; 80: 365-369
  • 6 Breit GA, Gross JH, Watenpaugh DE. et al. Near-infrared spectroscopy for monitoring of tissue oxygenation of exercising skeletal muscle in a chronic compartment syndrome model. J Bone Joint Surg Am 1997; 79: 838-843
  • 7 Roberts A, Franklyn-Miller A. The validity of the diagnostic criteria used in chronic exertional compartment syndrome: A systematic review. Scand J Med Sci Sports 2012; 22: 585-595
  • 8 Hislop M, Tierney P. Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols. Br J Sports Med 2011; 45: 956-958
  • 9 Flick D, Flick R. Chronic exertional compartment syndrome testing. Curr Sports Med Rep 2015; 14: 380-385
  • 10 Tucker AK. Chronic exertional compartment syndrome of the leg. Curr Rev Musculoskelet Med 2010; 3: 32-37
  • 11 Mohile N, Perez J, Rizzo M. et al. Chronic lower leg pain in athletes: overview of presentation and management. HSS J 2020; 16: 86-100
  • 12 de Bruijn JA, van Zantvoort APM, van Klaveren D. et al. factors predicting lower leg chronic exertional compartment syndrome in a large population. Int J Sports Med 2018; 39: 58-66
  • 13 Fouasson-Chailloux A, Menu P, Allorent J, Dauty M. Determination of the predictive clinical parameters to diagnose chronic exertional compartment syndrome. Eur J Sport Sci 2018; 18: 279-285
  • 14 Boody AR, Wongworawat MD. Accuracy in the measurement of compartment pressures: A comparison of three commonly used devices. J Bone Joint Surg Am 2005; 87: 2415-2422
  • 15 Moed BR, Thorderson PK. Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle. J Bone Joint Surg Am 1993; 75: 231-235
  • 16 Franklyn-Miller A, Roberts A, Hulse D, Foster J. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med 2014; 48: 415-416
  • 17 Packer JD, Day MS, Nguyen JT. et al. Functional outcomes and patient satisfaction after fasciotomy for chronic exertional compartment syndrome. Am J Sports Med 2013; 41: 430-436
  • 18 Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 1990; 18: 35-40
  • 19 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191-2194
  • 20 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
  • 21 Carter JV, Pan J, Rai SN, Galandiuk S. ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves. Surgery 2016; 159: 1638-1645
  • 22 Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ 2004; 329: 168-169
  • 23 Grimes DA, Schulz KF. Refining clinical diagnosis with likelihood ratios. Lancet 2005; 365: 1500-1505
  • 24 Leisenring W, Alonzo T, Pepe MS. Comparisons of predictive values of binary medical diagnostic tests for paired designs. Biometrics 2000; 56: 345-351
  • 25 Gu W, Pepe MS. Estimating the capacity for improvement in risk prediction with a marker. Biostatistics 2009; 10: 172-186
  • 26 Burrus MT, Werner BC, Starman JS. et al. Chronic leg pain in athletes. Am J Sports Med 2015; 43: 1538-1547
  • 27 Lohrer H, Malliaropoulos N, Korakakis V, Padhiar N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. Phys Sportsmed 2019; 47: 47-59
  • 28 Rajasekaran S, Finnoff JT. Exertional Leg Pain. Phys Med Rehabil Clin N Am 2016; 27: 91-119
  • 29 Hutchinson M. Chronic exertional compartment syndrome. Br J Sports Med 2011; 45: 952-953
  • 30 Aweid O, Del Buono A, Malliaras P. et al. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med 2012; 22: 356-370
  • 31 Paik RS, Pepple DA, Pepples D, Hutchinson MR. Chronic exertional compartment syndrome. BMJ 2013; 346: f33
  • 32 Davis DE, Raikin S, Garras DN. et al. Characteristics of patients with chronic exertional compartment syndrome. Foot Ankle Int 2013; 34: 1349-1354
  • 33 Bong MR, Polatsch DB, Jazrawi LM, Rokito AS. Chronic exertional compartment syndrome: diagnosis and management. Bull Hosp Jt Dis 2005; 62: 77-84
  • 34 Styf J. Chronic exercise-induced pain in the anterior aspect of the lower leg. An overview of diagnosis. Sports Med 1989; 7: 331-339
  • 35 Calvelli N, Vergès S, Rousseaux-Blanchi M-P. et al. Features of chronic exertional compartmental syndrome of the leg in elite Nordic skiers. Int J Sports Med 2020; 41: 196-202
  • 36 García-Mata S, Hidalgo-Ovejero A, Martinez-Grande M. Chronic exertional compartment syndrome of the legs in adolescents. J Pediatr Orthop 2001; 21: 328-234
  • 37 Kumar R, Indrayan A. Receiver operating characteristic (ROC) curve for medical researchers. Indian Pediatr 2011; 48: 277-287
  • 38 Barnes M. Diagnosis and management of chronic compartment syndromes: a review of the literature. Br J Sports Med 1997; 31: 21-27
  • 39 Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clin Orthop Relat Res 1975; 69-80
  • 40 Pierret C, Tourtier J-P, Blin E. et al. Chronic compartmental syndrome. a review of 234 patients. J Mal Vasc 2011; 36: 254-260
  • 41 Huang J, Qin K, Tang C. et al. Assessment of passive stiffness of medial and lateral heads of gastrocnemius muscle, Achilles tendon, and plantar fascia at different ankle and knee positions using the MyotonPRO. Med Sci Monit 2018; 24: 7570-7576
  • 42 Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep 2018; 8: 17064
  • 43 University Hospital, Angers. COmpartment Syndrome vaLidation Of Non Invasive Assessment of Tissue Pressure (COLONIA). clinicaltrials.gov; 2020