Microdialysis for chronic exertional compartment syndrome: a pilot study

Heinz Lohrer,Tanja Nauck,Jochen Klein,Tobias Schönberg

doi:10.1186/s13102-021-00245-9

Abstract

BackgroundDiagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. However, neither the methods used nor the interpretation of the obtained results are sufficiently standardized.MethodsIn the present pilot study, the metabolic state of CECS patients was investigated using microdialysis. We hypothesized that there was no difference in intramuscular concentrations of glucose, lactate, glutamate, and glycerol before and after exercise (H10) or between patients suffering from CECS and healthy control subjects (H20). This study was designed as an explorative case-control study (level of evidence III). Twelve patients suffering from CECS of the lower leg and six matched asymptomatic control subjects underwent microdialysis in the anterior (n = 7) or deep posterior compartment (n = 11) of the leg. Following ultrasound-guided insertion of the microdialysis catheters, 10-minute fractions of the dialysates were collected first during rest and then following fatigue- or pain-induced discontinuation of exercise. Dialysates were analysed for lactate, glucose, glutamate, and glycerol concentrations 6 × 10 min before and 6 × 10 min after exercise.ResultsExercise-induced increases in lactate, glutamate, and glycerol concentrations were detected in both CECS patients and control subjects (all p < 0.001). No differences between CECS patients and control subjects were found by comparing the intramuscular glucose, lactate, glutamate, and glycerol concentrations at rest and following exercise (all p > 0.05).ConclusionsWe found exercise-induced increases in the lactate, glutamate, and glycerol levels in skeletal muscle. However, the metabolic changes did not differentiate CECS patients from healthy subjects.Trial registrationThe registration trial number is DRKS00021589 on DRKS. ‘Retrospectively registered’. Date of registration: April 4, 2020.

Highlights

Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge
Two-way Analysis of Variance (ANOVA) for repeated measurements found no differences between the time courses of metabolites between the control and Chronic exertional compartment syndrome (CECS) groups
One-way ANOVA revealed that compared to ‘rest’, lactate, glutamate, and glycerol concentrations increased in the ‘peak’ phase following exercise in both groups (p = 0.01 to 0.05, respectively)

Summary

Introduction

Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. Chronic exertional compartment syndrome (CECS) is the most common entity under the “umbrella” term of exercise-induced leg pain. Non-traumatic activity-related pain in or over the involved compartment starts after an individually reproducible time or intensity of activity or running distance and increases until the pain forces the patient to stop the activity inducing the pain [1, 2]. CECS predominantly involves the anterior and/or posteromedial leg compartments of runners. The history reveals the typical clinical constellation of CECS and physical examinations present unremarkable findings. Clinical diagnosis relies on excluding any intervening pathologies [1, 2]. Most authors favour operative compartment release when conservative therapy fails [2]

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