Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg Kyle P. Lavery, M.D., Michael Bernazzani, B.S., Kevin McHale, M.D., William Rossy, M.D., Luke Oh, M.D., George Theodore, M.D. Arthroscopy Techniques Volume 6, Issue 3, Pages e649-e653 (June 2017) DOI: 10.1016/j.eats.2017.01.010 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 1 The patient is positioned supine on a standard operating table with a nonsterile thigh tourniquet. In this example of a right leg, the extremity is externally rotated at the hip into a figure-of-four position to aid in access to the medial side of the leg. An 8- to 10-cm medial longitudinal incision is made approximately 1 cm posterior to the subcutaneous border of the tibia. The image depicts a right leg in the supine position. (A, anterior; Di, distal; P, posterior; Pr, proximal.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 2 A scalpel is used to sharply create a 1-cm longitudinal incision in the fascia overlying the gastrocnemius and soleus muscle bellies. The image depicts a right leg in the supine position. (A, anterior; Di, distal; P, posterior; Pr, proximal.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 3 (A) A long, blunt Metzenbaum scissor is introduced into the fascial rent aiming distally. (B) The scissor is gently advanced distally, bluntly separating the fascia from the underlying muscle bellies and tendons. (C, D) Using a push-cut technique, the fascia is slowly incised distally to the level of the ankle. All images depict a right leg in the supine position. (A, anterior; Di, distal; P, posterior; Pr, proximal.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 4 The proximal fascia is then incised in a similar fashion. The image depicts a right leg in the supine position. (A, anterior; Di, distal; P, posterior; Pr, proximal.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 5 (A) Retracting the saphenous neurovascular bundle posteriorly, the fascia and subperiosteal tissues are incised from the posteromedial tibia using electrocautery. (B) The flexor digitorum longus is the first muscle belly encountered medially in the deep posterior compartment. The images depict a right leg in the supine position. (A, anterior; Di, distal; FDL, flexor digitorum longus; P, posterior; Pr, proximal; S, saphenous neurovascular bundle; T, tibia.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions
Fig 6 (A) Subperiosteal dissection is carried out proximally and distally from the tibial border to ensure complete deep posterior compartment release. (B) The superficial posterior compartment release is visualized as the saphenous neurovascular bundle is retracted anteriorly. The images depict a right leg in the supine position. (A, anterior; Di, distal; P, posterior; Pr, proximal; S, saphenous neurovascular bundle; T, tibia.) Arthroscopy Techniques 2017 6, e649-e653DOI: (10.1016/j.eats.2017.01.010) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions