To The Editor:

We read with interest the article, "Acute Compartment Syndrome of the Thigh Following Rupture of the Quadriceps Tendon. A Case Report."(1) The authors describe the clinical and intraoperative findings in a sixty-six year old patient who had fallen and sustained a quadriceps rupture. We would like to make the following points:

Acute compartment syndrome of the thigh is rare. Quadriceps rupture is common. Quadriceps rupture may be associated with a large, tense haematoma which is often very painful.(2) Physical signs of acute compartment syndrome include tightness of the involved compartment; pain with passive motion of the muscles passing through the compartment; weakness of these muscles; hypesthesia; paresthesia; and most importantly pain out of proportion to that expected with the injury(2). In the case the authors describe, there was no neurological dysfunction. The quadriceps rupture could have been entirely responsible for: the patient’s ‘moderate distress’; pain on moving the knee; and the retinacular tenderness and echymosis.

Moreover, the authors report that the signs were confined to the distal half of the anterior compartment of the thigh. Compartment syndrome by definition should involve the entirety of at least one compartment.

The authors’ diagnosis in this case appears to hinge on the measured compartment pressure of 50mmHg. However, the authors do not state how many readings were taken, and at which sites. We suggest that if the transducer was placed directly into a large, tense but discrete haematoma that was confined to the musculotendinous unit, this would also give a high reading. Did the authors obtain readings from the proximal (clinically normal) half of the compartment?

We also suggest that the authors’ operative technique casts doubt upon the diagnosis of compartment syndrome. The standard operative technique for acute compartment syndrome of the thigh involves an incision which runs the full length of the compartment and, crucially, a fasciotomy(2). Figure 2 depicts an incision which is not dissimilar from that commonly employed for knee arthroplasty. In addition,no fasciotomy was performed.

References:

(1) Kuri JA II, DiFelice GS. Acute Compartment Syndrome of the Thigh Following Rupture of the Quadriceps Tendon. A Case Report. J. Bone Joint Surg. Am., Feb 2006; 88: 418 - 420.

(2) Azar FM. Traumatic disorders. In: Canale ST, editor. Campbell's Operative Orthopaedics. 10th ed. Philadelphia: Mosby; 2003. p2474 .