Outcomes of Fasciotomy Versus Conservative Management for Chronic Exertional Compartment Syndrome: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate and compare the effectiveness of surgical fasciotomy and conservative management for chronic exertional compartment syndrome (CECS) concerning symptom relief, functional recovery, and patient satisfaction. A comprehensive search of PubMed, Scopus, Google Scholar, and Cochrane Library identified studies comparing surgical fasciotomy with conservative management for CECS. Four studies met the inclusion criteria, comprising both retrospective and prospective cohort designs. The primary outcomes were pain reduction (assessed using the visual analog scale), return to activity (measured by the Tegner scale), and functional recovery (evaluated through the Short Form-36 (SF-36) quality-of-life score). Secondary outcomes included complication rates and patient satisfaction. Statistical analyses were performed to calculate standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs), while heterogeneity was assessed using the I² statistic. Surgical fasciotomy demonstrated significantly greater pain reduction compared to conservative management (SMD: -0.46, 95% CI: -0.74 to -0.17, p = 0.002), with low heterogeneity (I² = 13%). Patient satisfaction was also significantly higher in the surgical group (OR: 3.51, 95% CI: 2.19 to 5.60, p < 0.00001). However, no significant difference was observed in return-to-activity rates (OR: 3.70, 95% CI: 0.53 to 25.96, p = 0.19), with high heterogeneity (I² = 88%). Complications associated with fasciotomy included hematomas, nerve injuries, and scar-related issues, while conservative treatment showed moderate effectiveness in milder cases. Surgical fasciotomy offers superior pain relief and higher patient satisfaction compared to conservative management for CECS. However, the evidence for return-to-activity rates remains inconsistent. Future research should focus on randomized controlled trials and standardized outcome measures to refine treatment strategies.