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OBJECTIVES To evaluate the short- and long-term patient reported outcomes of acute compartment syndrome (ACS) complicating a fracture of the tibial diaphysis. DESIGN Retrospective review. SETTING Academic orthopaedic trauma centre. PATIENTS We retrospectively identified 559 patients from a trauma database over a 7-year period. Forty-one patients (7.3%) underwent fasciotomies for ACS and were included in the study. A matched cohort of 185 patients who did not develop ACS were used as controls. INTERVENTION Fasciotomy for ACS. MAIN OUTCOME MEASUREMENTS The primary short-term outcome measure was the development of complications, including infection, non-union and further surgery. The primary long-term outcome measure was the patient reported Euroqol-5D-3L (EQ-5D). Secondary long-term outcomes included the Oxford Knee Score (OKS), the Manchester-Oxford Foot Questionnaire (MOXFQ) and satisfaction. RESULTS There was no significant difference between ACS and non-ACS groups in the overall rate of infection (17% vs 9.2% respectively; p=0.14), deep infection (4.9% vs 3.8%; p=0.67) or non-union (4.9% vs 7.0%; p=1.00). There were 206 patients (21 ACS) with long-term outcome data at a mean of 5 years (1-9). There was no significant difference between groups with respect to the EQ-5D (p=0.81), OKS (p=0.24) or MOXFQ (p=0.63). Patient satisfaction was reduced in patients who developed ACS (77 vs 88; p=0.039). CONCLUSION These data suggest that when managed with urgent decompressive fasciotomies, ACS does not appear to have a significant impact on long-term patient reported outcome, although patient satisfaction is reduced. LEVEL OF EVIDENCE III - Retrospective cohort study.