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Anatomic Structures at Risk during Minimal-Incision Endoscopically Assisted Fascial Compartment Releases in the Leg

Background Although minimal-incision surgical techniques are recommended for treatment of chronic exertional compartment syndrome of the leg, which is an increasing problem among endurance athletes, there is little information about anatomic correlation with structures at risk. Hypothesis Fascial releases performed with endoscopic assistance are safer than the percutaneous method. Study Design Controlled laboratory study. Methods Ten endoscopically assisted and six percutaneous fascial releases were performed on 16 human cadaveric lower limbs. Formal dissection documented length of release and proximity of structures at risk. Results Endoscopically assisted fascial release led to reduced risk of superficial peroneal nerve injury compared with a blind percutaneous release through a 2- to 3-cm incision. Both techniques had unacceptable rates of saphenous vein injury (30% to 100%), and releases performed percutaneously had greater length. Conclusions Risk of superficial peroneal nerve injury was less with single-incision endoscopically assisted fascial release. Risk of injury to the saphenous vein from either technique appeared to be unacceptable. Clinical Relevance Single-incision endoscopically assisted fascial release of the anterior and lateral compartments may be a useful technique with low risk of peroneal nerve injury. Clinical studies will confirm whether this technique proves safer or more effective than those currently used for chronic exertional compartment syndrome of the leg.