Conservative vs Surgical Treatment in Exercise-Related Leg Pain

Research Paper Title

Historic cohort: outcome of chronic exertional compartment syndrome-suspected patients.


Exercise-related leg pain (ERLP) may be caused by chronic exertional compartment syndrome (CECS), occurring mainly in athletes and military recruits.

In military populations, the effectiveness of surgical treatment in CECS is debated.

The purpose of this study was to assess the outcome of surgical treatment for CECS in Alrijne Hospital (the Netherlands), a civilian hospital with supraregional referral function.


A historic cohort study was performed on patients with ERLP who were suspected for CECS and were referred for intracompartmental pressure measurement (ICPM) from 2013 to 2017 (n=160).

Patient demographics, ICPM and survey response were analysed.


The mean delay before visitation was 29.0±30.3 months.

When comparing surgical-treated patients with CECS with conservative-treated patients with ERLP, surgical-treated patients were more satisfied, reported better recovery towards former level of performance (2.8±2.0 vs 3.9±1.7 and 2.5±1.6 vs 3.2±1.4 on a 7-point Likert scale, respectively) and better subjective injury status (79.3±22.6 vs 63.5±27.4 using the Single Assessment Numeric Evaluation score).

Treatment satisfaction was 75.0% in surgical-treated CECS versus 51.4% in conservative-treated ERLP.


Civilian patients report improved functional outcomes after fasciotomy for CECS.

Future research should focus on non-invasive diagnostic options and methods to determine which treatment is the most appropriate for each individual patient.


Maksymiak, R., Ritchie, E, Zimmermann, W., Maliko, N., van der Werve, M., Verschure, M. & Hoencamp, R. (2020) Historic cohort: outcome of chronic exertional compartment syndrome-suspected patients. BMJ Military Health. pii: jramc-2019-001290. doi: 10.1136/jramc-2019-001290. [Epub ahead of print].


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