Your lower leg is divided into 4 compartments by partitions between the two bones . The muscles within these compartments are surrounded by tissue known as fascia. When you exercise, blood flow to your muscles increases and your muscles swell. In exertional compartment syndrome, the fascia is too tight to allow this swelling and the muscles become swollen to the point where the blood flow becomes interrupted. The lack of blood flow causes the muscles to become starved of oxygen and this causes pain. Stopping the exercise leads to a decrease in the pressure within the compartments, allowing the blood flow to resume and the pain usually goes away quickly. Sometimes the pain will respond to activity modification, physiotherapy and shoe wear adjustments. Sometimes no matter what you do the pain does not go away and if this is the case, surgery to increase the volume of the compartment by splitting the fascia becomes an option.
Fasciotomy involves making incisions over the tight compartments in the leg in order to release the tight fascia enclosing the muscles. The incisions vary in length and number depending on the surgeon’s preference and which compartments need releasing. Releasing the fascia usually means that the muscles will now have adequate room to swell when you exercise. Most fasciotomy surgery will require you to stay in hospital for one night. You will be given a time and a date for your surgery along with any special instructions. Both the surgeon and the anaesthetist will see you before the operation. They will explain the procedure and ask you to sign a consent form. You should confirm what leg is to be operated on (fasciotomy surgery usually involves both legs but not always). You should also ask for more information if you wish. At the end of the procedure the wounds are usually injected with local anaesthetic to help with pain relief. A small drain is placed to collect bleeding – this will be removed before you leave hospital. Finally a padded bandage is applied over dressings to seal off the wounds.
The incision is made between the 2 marks on the leg as seen above and is usually between 8-10cm long.
You will remain in hospital overnight with your legs elevated. Most people will go home the next day once the drains are removed. Although you will be able to walk after the operation you will be given crutches and advised to spend as little time on your feet as possible. This is especially important in the first week following surgery to decrease the chances of the legs swelling and causing problems with healing of the wounds. The bandages are left on until you are seen in clinic usually 7-10 days after the operation. If you wish to shower or bathe, tape a plastic bag over your knees to stop the wounds getting wet.
When the anaesthetic wears off you should expect some pain in the legs but this should not be severe. If you experience pain you should take the tablets provided and elevate the legs. If the bandage feels too tight it can be taken off and reapplied more loosely.
If you have a sedentary job and the wounds are healing nicely you may return to work after 10-14 days. If your job involves heavy manual labour you should wait to receive clearance from your surgeon. You should be able to drive a car when you have full control of your legs and your wounds are healed.
When you leave the hospital you should have an appointment card with a time for your follow-up check at the clinic. If not, telephone to make an appointment.
Possible complications of fasciotomy include anaesthetic complications, wound healing problems arising from infection or bleeding which can in turn lead to unsightly scarring. Deep vein thrombosis ( DVT ) or blood clots in the calves is also a risk and it is possible that you may have some numbness around the wounds or on the foot but this usually becomes less noticeable with time. There is also a small chance that the surgery does not relieve all of your symptoms.
At your first clinic follow up appointment you will be advised to place a hypoallergenic paper tape on your wounds to help minimize scarring.
The knee is a modified hinge joint between the end of the femur (thigh bone) and the top of the tibia (shin bone). There are four main ligaments connecting these two bones.
The medial and lateral collateral ligaments (MCL / LCL) run along the inner and outer parts of the knee respectively and prevent the knee from bending outward and inward.
The anterior cruciate ligament (ACL) lies in the middle of the knee. Its function is to stop the tibia from sliding out in front of the femur. It also provides rotational stability to the knee. The posterior cruciate ligament (PCL) which is not labelled in the diagram prevents the tibia from sliding backwards under the femur. These two ligaments cross each other inside the knee forming an "X.". This is why they are called “cruciate” (cross-like) ligaments.
When an ACL injury occurs, the knee becomes less stable. This can be a problem because this instability can make sudden, pivoting movements difficult. Many patients are able to compensate for an ACL injury by either modifying their recreational activities or strengthening the knee, however, in some individuals, particularly in high demand sports, recurrent instability or 'giving way' can occur. This may make it impossible for the individual to take part in these types of activity. In addition recurrent episodes of instability can cause damage to the joint surfaces of the knee or the knee cartilages (menisci) and make patients more prone to developing arthritis.
Once it has been ruptured the ACL is unable to heal. It is possible in selected patients to stabilise the knee by performing an operation to reconstruct the ligament. This procedure does not however make the knee normal and may result in some initial stiffness and discomfort. A new ACL can be ‘made’ using either tendons taken from the hamstrings behind the knee or from the patellar tendon at the front of the knee. The choice of graft is dictated by a number of factors that will be assessed by your surgeon and may be discussed during the preoperative consultation.
In addition to undertaking cruciate ligament reconstruction your surgeon will perform a thorough arthroscopic (keyhole) examination of the knee to assess the cartilages and joint surfaces for any evidence of damage. Injured structures will be treated by either repairing or removing the damaged parts as appropriate.
Although the risks of surgery are minimised wherever possible, no procedure is entirely risk-free. Possible complications of surgical reconstruction of the ACL include anaesthetic complications, wound infections and deep venous thrombosis (DVT) or blood clots in the calves. It is common to have some numbness around the scar which usually becomes less noticeable with time. Stiffness and pain in the knee can occur following surgery but are unlikely if rehabilitation protocols are followed. Rupture of the ACL graft can occur but this is a rare occurrence.
You will be given a time and date for your surgery along with any special instructions. Please ensure that you bring any x-rays or scans to the hospital on the morning of the operation. Both the surgeon and anaesthetist will see you before the operation. They will explain the procedure and ask you to sign a consent form. You should confirm which knee is to be operated on and take the opportunity to ask for more information if you wish. At the end of your operation the knee will be filled with local anaesthetic to help with pain relief. In addition your anaesthetist may have used a local nerve block to numb the area in the postoperative period. You will usually stay in hospital for one night following surgery.
Your rehabilitation programme is detailed separately. It is important that you proceed through the programme at a steady pace if necessary with guidance from your physiotherapist. The programme involves a series of activities including walking, home and gym exercises, and periods of time on an exercycle. In the initial stages the goals are to reduce the swelling around the knee and regain full extension of the knee. Later in the process the programme works on knee strength and control prior to beginning sports specific training. You must be walking without crutches and you must have full control of your leg to be safe driving.