More with compartment syndrome - maybe not the standard treatment?

As mentioned in another post, after struggling around with lower limb pain, worsening on exertion but flaring up with simple things like walking up the street, I was diagnosed with possible compartment syndrome. I am not a triathlete, but am fit and undertake a lot of other training, much of work related (military).

I was able to see a sports physician, who undertook compartment pressure testing. All four compartments were elevated at rest (above 20), and distinctively elevated after exercise (40 to 50). In the meantime I have been treated with orthotics and heavy physical restrictions, such as no running/walking strenuously. Cycling does not seem to flare the symptoms too much, so I have been undertaking a lot of that. Fortunately/unfortunately for me, the doc also discovered that my previously reconstructed left knee was completely unstable again. Multiple scans and xrays have been undertaken - the most interesting result being that my popliteal vein is squashed very flat by the surrounding musculature.

I was initially referred to a vascular surgeon who agreed that I needed four fasciotomies. I was also referred to an orthopedic surgeon who agreed I need a revision of the reconstruction on my left knee. In the meantime, waiting for the surgery time to come around, the surgeons got talking, and decided to change their plan to have me injected with botox (souleus and gastrocneimius) to paralyze and decompress the muscles around the squashed vein.

This did not sit so well with me. I am more than happy with having my knee reconstructed, and the doctors are quite curious to see the result that that has upon my compartment syndrome, seeing the left side is worse than the right. I have re-challenged their plan of treatment after getting a “heads-up” on the issues with botox - relatively short effect, and why would I want my muscles paralyzed?

The result being that I will still receive the knee recon, but now will also have both popliteal fossas decompressed surgically. More pain, more rehab, more scarring but I have been told that this is much more likely to have a permanent effect, which is better for me and better for the military. They will assess whether this increased blood flow will relieve all the compartment syndrome pain, and if not, I can still have fasciotomies and/or botox therapy.

Has anyone else experienced the popliteal decompression? I have been informed that the legs will require to be done separately, so I am looking at three separate surgeries at this point.

Still, I am looking forward (in 12 months or so) to being able to return fully to sport and training. It does sound like a long haul, whew! And guys digs scars right (or is just the ladies?)?

Nifty - this is a heck of a post! You’re talking about surgery that carries significant potential risk a little more lightly than you might. Perhaps you need to discuss the long term of a second reconstruction, how much arthritis is present (and I can’t believe the answer would be none), what are the condition of your menisci, what is the success rate of doing this operation a second time and how is success measured? Your treating physician would be able to give you the best guess based on your exam, x-rays, previous procedures, etc. Doing anything with regard to the compartment issue may be a bit much in this setting. I think you need more info from your surgeon and not just the ST’ers to get done what’s right for you! Good luck.

thanks for the reply!

I realize this is not to be taken lightly, it is a lot of surgery, with risks and I have carefully considered this. I have spent considerable time in discussion with various doctors regarding my options.

Simple fact. I am military, I need a stable knee to prop and run with if required. Also, on a personal note, I relish the opportunity to regain back a stable and strong leg. My previous recon was all a bit dodgy in the sense I received next to no rehab, and I have probably been getting by in life and training with good proprioception (gosh, I hope that is the right word) and avoiding certain activities that require me to prop and turn.

My surgeon has stated that I have only a little arthritis, and he will assess what other damage there is when he undertakes the operation. He has reported that all of the scans, xrays etc, have shown that my knee looks pretty good and he is very optimistic that this intervention will bring about a very positive result.

I have been asked what I want with this surgery, and my reply to that is functionality. I want to be fully functional within my job and within my training and sports. For this is occur, I need a second reconstruction.

The compartments, well, I have little control over that. The symptoms are now very considerable with just walking around, and undertaking work, even with significant physical resitrictions. It is a considerable problem, and seems to be only getting worse with time and rest, as opposed to better.

So, I guess what I was looking for was people who have been through some of the operations and rehabilitations that I am going to go through. I hate surprises, and I have found the information I got reading about peoples recovery from fasciotomies, etc helpful. It is also helpful to read the positive results, it helps me focus on the long term result, which will be normal function. And if people are curious about this, and want feedback from me as it happens, I can supply this also.

Believe me, I take NONE of this lightly. I am not looking forward to some of the pain I will be in, plus the fact that I will be stuck in hospital, leg up, for quite some time. But, I do trust the surgeons and doctors I have seen, they have given me some good information (when pressed and not allowed to be rushed). I believe them when they have said that the current plan is most likely to have the best results. And the long term goal? A stable, trustworthy knee and legs I can run on again. Full functionality.

oh! and to bring it back to the correct context for this forum…

I am a very strong swimmer, and a decent cyclist, with a nice bike (rehab present to self) on the way. I want to be fully functional again, so I can run.

And, I always wanted to get into triathlons! So, you never know… maybe in 12 months…?

Nifty - although it may seem reasonable to you, the number of people who return to “full functionality” after a revision of a knee reconstruction is lower than you might like. Sorry to be the bearer of bad news but in anyone’s knee that I had to redo, this was one of the ley points in the pre-op planning. That, coupled with the increased potential for complication or infection. You may have to lower your sights a bit.