Email: info@BSBortho.com
For runners, military personnel, and competitive athletes, chronic exertional compartment syndrome (CECS) can be one of the most frustrating causes of exercise-induced leg pain. Symptoms often begin predictably during activity, forcing athletes to stop exercising, only to resolve shortly after rest. While conservative treatment may help some individuals, surgery remains the gold standard for patients with persistent symptoms.
A recently published technical report describes an innovative ultrasound-guided percutaneous fasciotomy technique that may offer a less invasive alternative to traditional surgery while potentially reducing complications and shortening recovery (Machado et al, 2024).
CECS occurs when pressure builds within one or more muscle compartments during exercise. Because the surrounding fascia is relatively noncompliant, increased muscle volume during activity leads to elevated compartment pressures that reduce blood flow and compress nerves.
CECS is an overuse injury characterized by five cardinal symptoms pain that occur predictably during exertion and resolve with rest (Ding et al, 2020).
Common symptoms include:
It predominantly affects young, athletic populations, with military service members (54%) and athletes (29%) comprising the majority of surgical cohorts (Campano et al, 2016). Diagnosis is confirmed using pre-exercise pressure and post-exercise pressure testing (Pedowitz et al, 1990).
Clinical predictors such as post-exercise muscle hardness and fascial hernia can identify CECS with 86% accuracy (Vignaud et al, 2021). The anterior and lateral compartments of the leg are most frequently involved.
When physical therapy, gait modification, activity changes, and other conservative treatments fail, fasciotomy is often recommended. Traditional open fasciotomy remains the predominant surgical technique, with systematic reviews reporting satisfaction rates of 85% (±13%) and return-to-activity rates of 80% (±17%) (Vogels et al, 2020).
Traditional surgery involves opening the fascia surrounding the affected compartment to relieve pressure. While outcomes are generally favorable, complications are not uncommon (Ding et al, 2020), including:
Mean time to return to sport after open fasciotomy is approximately 5.5 months, and 38% of patients report postoperative paresthesia at long-term follow-up (Moore et al, 2025).
These concerns have fueled interest in less invasive surgical approaches.
The authors describe a technique performed through a millimeter-sized skin incision using continuous ultrasound visualization and a specialized hooked blade (Machado et al, 2024).
The procedure consists of four key steps:
Unlike blind percutaneous techniques, ultrasound allows the surgeon to continuously visualize nearby nerves and confirm proper instrument placement throughout the procedure.
One of the greatest advantages of ultrasound-guided surgery is visualization.
The superficial peroneal nerve is among the most vulnerable structures during anterior and lateral compartment fasciotomy. Injury to this nerve can result in chronic numbness, painful neuromas, or persistent weakness.
Real-time ultrasound enables the surgeon to:
This precision is one reason ultrasound-guided surgery has become increasingly popular across multiple orthopedic procedures.
The study evaluated the technique in six cadaveric specimens (24 fasciotomies) to determine technical feasibility and safety (Machado et al, 2024)..
Key findings included:
These findings demonstrate that the procedure can reliably achieve adequate fascial release while preserving nearby neurovascular structures in a cadaveric model.
Although the results are promising, patients should recognize that this was a cadaveric technical study, not a clinical outcomes study.
Questions that still require investigation include:
Clinical trials in living patients will ultimately determine whether ultrasound-guided fasciotomy becomes a new standard of care.
Minimally invasive ultrasound-guided procedures continue to expand throughout orthopedic and sports medicine. By combining real-time imaging with small-incision surgery, physicians can often perform highly targeted procedures while minimizing soft tissue disruption.
For CECS, ultrasound-guided percutaneous fasciotomy has the potential to offer:
Although additional clinical evidence is needed, this technique represents another example of how ultrasound is transforming musculoskeletal surgery and may significantly improve care for active patients with chronic exertional compartment syndrome.
CECS is an exercise-induced condition in which pressure builds inside muscle compartments, causing pain, tightness, numbness, and weakness during activity that typically resolves with rest.
It most commonly affects runners, military personnel, soccer players, dancers, and other athletes performing repetitive lower-extremity exercise.
Diagnosis is based on clinical history, physical examination, imaging to exclude other causes, and often compartment pressure testing before and after exercise. Learn more about compartment testing here.
It is a minimally invasive procedure performed through a tiny skin incision using real-time ultrasound to visualize the fascia, surgical instrument, and nearby nerves while releasing the affected compartment.
The current evidence is promising. Existing data primarily demonstrate technical feasibility and safety of this procedure.
At Boston Sports & Biologics, these procedures are performed in the office.
Traditional fasciotomy often requires 6–12 weeks before unrestricted activity. Ultrasound-guided fasciotomy has the potential to shorten recovery.
(781) 591-7855
20 Walnut St
Suite 14
Wellesley MA 02481
Campano D, Robaina JA, Kusnezov N, Dunn JC, Waterman BR. Surgical Management for Chronic Exertional Compartment Syndrome of the Leg: A Systematic Review of the Literature. Arthroscopy. 2016 Jul;32(7):1478-86. doi: 10.1016/j.arthro.2016.01.069. Epub 2016 Mar 24. PMID: 27020462.
Ding A, Machin M, Onida S, Davies AH. A systematic review of fasciotomy in chronic exertional compartment syndrome. J Vasc Surg. 2020 Nov;72(5):1802-1812. doi: 10.1016/j.jvs.2020.05.030. Epub 2020 May 27. PMID: 32473344.
Machado A, Fauchille T, Fairag R, Cornacchini J, Bronsard N, Ciais N, Gonzalez JF, Rudel A, Micicoi G. Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome. Arthrosc Tech. 2024 Sep 23;13(11):103119. doi: 10.1016/j.eats.2024.103119. PMID: 39711887; PMCID: PMC11662872.
Moore M, Lezak B, Berzolla E, Hughes A, Seidenberg J, Kaplan D, Strauss E, Jazrawi L. Medium- to Long-term Outcomes of Fasciotomy for Chronic Exertional Compartment Syndrome: A 6-Year Mean Follow-up Study. Sports Health. 2025 Sep-Oct;17(5):958-964. doi: 10.1177/19417381241288899. Epub2024 Oct 21. PMID: 39434455; PMCID: PMC11556667.
Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990 Jan-Feb;18(1):35-40. doi: 10.1177/036354659001800106. PMID: 2301689.
Vignaud E, Menu P, Eude Y, Maugars Y, Dauty M, Fouasson-Chailloux A. A Comparison of Two Models Predicting the Presence of Chronic Exertional Compartment Syndrome. Int J Sports Med. 2021 Oct;42(11):1027-1034. doi: 10.1055/a-1342-8209. Epub 2021 Jan 13. Erratum in: Int J Sports Med. 2021 Dec;42(14):e4. doi: 10.1055/a-1376-9928. PMID: 33440444.
Vogels S, Ritchie ED, van Dongen TTCF, Scheltinga MRM, Zimmermann WO, Hoencamp R. Systematic review of outcome parameters following treatment of chronic exertional compartment syndrome in the lower leg. Scand J Med Sci Sports. 2020 Oct;30(10):1827-1845. doi: 10.1111/sms.13747. Epub 2020 Jul 24. PMID: 32526086; PMCID: PMC7540008.
Learn how ultrasound-guided percutaneous fasciotomy may revolutionize treatment for chronic exertional compartment syndrome with faster recovery and smaller incisions.
Read MoreResearchers used artificial intelligence and natural language processing to identify Shoulder Injury Related to Vaccine Administration (SIRVA) cases from over 3.7 million vaccinations. Learn what the study found, how
Read More