Project Details
Description
Funded by Defense Health Agency
The current standard for definitive treatment of CECS is surgical fasciotomy of the involved compartments. According to a 2016 systematic review, surgical intervention for CECS is successful in only 66% of those affected, with 13% of patients reporting complications from surgery, and 6% needing a repeat procedure. A 2014 retrospective review of military members showed that only 59% of patients who underwent elective fasciotomy for CECS were able to return to full duty while 22% of the patients that were treated with fasciotomy were eventually medically discharged. One of the reasons for the limited success rate, is an incomplete understanding of the pathophysiology coupled with proper patient selection.
Military sports medicine clinics at Fort Belvoir Community Hospital (FBCH) and USU have been utilizing BoNT-A injections for the non-surgical treatment of CECS. A retrospective review of patients with CECS treated with BoNT-A at FBCH Sports Medicine Clinic from 2014 to 2017 provided data on twenty-nine patients who were treated with BoNT-A for CECS. Prior to treatment, none of the 29 patients were able to perform their desired activity and 24% were unable to run one mile without severe leg pain. After botulinum injections, these numbers improved to 66% and 72% respectively. Sixty-nine percent of patients reported that they were satisfied or somewhat satisfied with their treatment, twelve patients continued to have sustained relief by the time they were contacted, and seven patients experienced a recurrence of symptoms. In those with recurrence, the mean duration of improvement was 7.8 months. Of note,11 patients received both BoNT-A and fasciotomy during their treatment course. Only one patient reported a favorable response to fasciotomy and failure with BoNT-A, suggesting that BoNT-A injections might be predictive of success with fasciotomy.
The purpose of this grant application is to create a registry across all MTFs for CECS to compare diagnostic and therapeutic data. We will simultaneously assess the effectiveness of non-surgical treatments options for chronic exertional compartment syndrome as well as test the use of xylocaine injections to predict success for non-surgical or surgical options at selected sites. This study will also determine if successful gait retraining, either home based or supervised, is essential to positive results Furthermore this study will also determine if BoNT-A injections plus gait retraining is better than either treatment alone. Finally, this study would determine if xylocaine injections could predict who will benefit from BoNT-A injections or fasciotomy.
The current standard for definitive treatment of CECS is surgical fasciotomy of the involved compartments. According to a 2016 systematic review, surgical intervention for CECS is successful in only 66% of those affected, with 13% of patients reporting complications from surgery, and 6% needing a repeat procedure. A 2014 retrospective review of military members showed that only 59% of patients who underwent elective fasciotomy for CECS were able to return to full duty while 22% of the patients that were treated with fasciotomy were eventually medically discharged. One of the reasons for the limited success rate, is an incomplete understanding of the pathophysiology coupled with proper patient selection.
Military sports medicine clinics at Fort Belvoir Community Hospital (FBCH) and USU have been utilizing BoNT-A injections for the non-surgical treatment of CECS. A retrospective review of patients with CECS treated with BoNT-A at FBCH Sports Medicine Clinic from 2014 to 2017 provided data on twenty-nine patients who were treated with BoNT-A for CECS. Prior to treatment, none of the 29 patients were able to perform their desired activity and 24% were unable to run one mile without severe leg pain. After botulinum injections, these numbers improved to 66% and 72% respectively. Sixty-nine percent of patients reported that they were satisfied or somewhat satisfied with their treatment, twelve patients continued to have sustained relief by the time they were contacted, and seven patients experienced a recurrence of symptoms. In those with recurrence, the mean duration of improvement was 7.8 months. Of note,11 patients received both BoNT-A and fasciotomy during their treatment course. Only one patient reported a favorable response to fasciotomy and failure with BoNT-A, suggesting that BoNT-A injections might be predictive of success with fasciotomy.
The purpose of this grant application is to create a registry across all MTFs for CECS to compare diagnostic and therapeutic data. We will simultaneously assess the effectiveness of non-surgical treatments options for chronic exertional compartment syndrome as well as test the use of xylocaine injections to predict success for non-surgical or surgical options at selected sites. This study will also determine if successful gait retraining, either home based or supervised, is essential to positive results Furthermore this study will also determine if BoNT-A injections plus gait retraining is better than either treatment alone. Finally, this study would determine if xylocaine injections could predict who will benefit from BoNT-A injections or fasciotomy.
Key findings
Data analysis phase
| Status | Active |
|---|---|
| Effective start/end date | 1/01/18 → … |
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