Introduction Endoscopic treatment of intractable chronic exertional compartment syndrome (CECS) of the lower leg in athletes is reported rarely and anecdotically.

Methods We developed a minimally invasive, endoscopically assisted technique for release of CECS of the lower leg. Follow-up was performed by telephone interview 47 months (range 5 months to 7 years) after surgery.

Results 38 compartments were released in 17 athletes (19 deep posterior, 16 anterior and 3 lateral compartments). All these patients were available for follow-up analyses. No complications were seen following anterior and lateral compartment decompression. Contrasting to this, two patients operated under tourniquet for deep posterior compartment syndrome suffered intraoperative haemorrhage and open revision surgery was required. No complications due to vascular injuries were seen in all further patients when the tourniquet was omitted. Ten patients returned to previous sport activity. At follow-up, results were good or excellent in 10 out of 17 patients. Visual analogue pain scale improved from 7.4 (range 5–9) before surgery to 2.4 (range 1–8) at follow-up (p = 0.0005).

Discussion Our data indicate that endoscopic release for CECS of the lower leg is feasible und successful. The procedure is at risk for vascular complications during deep posterior compartment fasciotomy. Consequently, it is emphasised to perform the procedure without tourniquet.