Evaluation of Emerging Technologies to Aid in the Detection and Diagnosis of Acute Extremity Compartment Syndrome

<b>Background/Objectives</b>: The diagnosis of acute compartment syndrome (ACS) of the extremities is typically based on subjective clinical signs and symptoms, highlighting the need for user-friendly diagnostic tools to improve accuracy and reliability. This study evaluates the performance of two commercial devices, the MY01^® continuous pressure monitoring system and the Moxy Monitor near-infrared spectroscopy-based system, against a reference standard of continuous intracompartmental pressure (ICP) monitoring in a preclinical ACS model. <b>Methods</b>: ACS was induced in the anterior compartment of the distal hind limb in eight Yorkshire pigs using a balloon displacement model. ICP was incrementally elevated and maintained for four hours at >30 mmHg above mean arterial pressure. This was followed by balloon deflation and reperfusion. Final assessments were performed at 24 h post-injury. ICP measurements from the MY01^® and muscle oxygen saturation (SmO₂) data from the Moxy Monitor were compared to reference ICP measurements. Histologic analysis of muscle tissue was performed to assess the severity of necrosis. <b>Results</b>: The MY01^® provided accurate ICP measurements, with a mean bias of 2.21 ± 18.77 mmHg during pre-ischemia, 4.86 ± 10.43 mmHg during reperfusion, and 4.69 ± 3.28 mmHg 24 h post-injury, compared to reference probes. Correlation at 24 h post-injury was (r = 0.86, R² = 0.73, <i>p</i> < 0.0001). In contrast, the Moxy Monitor failed to detect significant differences in SmO₂ between injured and control limbs at 24 h post-injury, despite pronounced ICP differences. Our volumetric displacement ACS model demonstrated its efficacy as a testing platform by allowing for controlled, incremental elevation in ICP and sustaining elevated ICP levels after 24 h. Histologic evaluation confirmed extensive muscle damage, including edema and necrosis. <b>Conclusions</b>: The MY01^® provides accurate, continuous ICP monitoring, supporting its clinical utility in ACS diagnosis. However, the use of near-infrared spectroscopy-based systems such as the Moxy Monitor for ACS diagnosis and management should continue to be critically scrutinized.