Association Between Intracompartmental Pressures in the Deep Posterior Compartment of the Leg and Conservative Treatment Outcome for Exercise-Related Leg Pain in Military Service Members

OBJECTIVE: To evaluate the relationship between intracompartmental pressure (ICP) values of the deep posterior compartment and the outcomes of a comprehensive conservative outpatient treatment program in service members with chronic exercise-related leg pain. DESIGN: Historic cohort study. SETTING: Department of sports medicine at a military secondary care facility. PARTICIPANTS: During the 5-year study period, 266 military patients completed a treatment program for chronic exercise-related leg pain. Eighty-three service members with 145 affected legs met all inclusion criteria (N=83; 59 men, 24 women; median age, 22 years). MAIN OUTCOME MEASURES: The primary outcome measure was return to active duty. The secondary outcome measure was development of acute on chronic compartment syndrome. A generalized linear mixed model was used to identify predictor variables associated with return to active duty, including ICP values of the deep posterior compartment and Single Assessment Numeric Evaluation (SANE) score. RESULTS: Sixty service members (72%) successfully returned to active duty. No association between ICP values of the deep posterior compartment and treatment outcome was found (odds ratio, 1.02; 95% confidence interval, 0.97-1.07; P=.50). A low SANE score (ie, more severe symptoms at baseline) was negatively associated with primary outcome (odds ratio, 0.95; 95% confidence interval, 0.90-0.99; P=.01). None of the patients developed acute on chronic compartment syndrome during the treatment program. CONCLUSIONS: There was no association between a single postexercise ICP value of the deep posterior compartment of both legs in military service members and return to active duty after a comprehensive conservative outpatient treatment program. None of the patients developed acute on chronic compartment syndrome. In this population, ICP measurement of the deep posterior compartment can be safely postponed until conservative treatment fails and surgical treatment is considered.