Popliteal entrapment syndrome: diagnostic, surgical management and short-term results of a ten-year experience

A rare case of type III popliteal artery entrapment syndrome causing popliteal pseudoaneurysm

Here, we report the case of a 30-year-old male who presented with acute right calf muscle pain. Computed tomography angiography revealed a popliteal artery aneurysm in the midsection. Popliteal fossa muscle tissue evaluation revealed that the popliteal artery aneurysm was located beneath an anomalous muscle bundle. Thus, the patient was diagnosed with type III popliteal artery entrapment syndrome and treated surgically. The patient was asymptomatic at rest and during physical activity 4 months after surgery with unobstructed bloodstream in the right popliteal artery. Popliteal artery entrapment syndrome should be considered in young male patients with popliteal artery pseudoaneurysms without atherosclerosis, hereditary diseases, or infections and treated surgically.

Exercise transcutaneous oximetry in functional popliteal artery entrapment syndrome diagnosis

INTRODUCTION

Functional popliteal artery entrapment syndrome is a subtype of popliteal artery entrapment syndrome (PAES) without vascular disease or musculotendinous anomaly behind the knee. Symptoms are induced by popliteal artery extrinsic compression, leading to calf pain during lower limbs exercise. Non-invasive tests are still required to improve the diagnostic management of functional PAES. Exercise transcutaneous oxygen pressure (Ex-tcpO2) is of interest to provide objective arguments for the presence of regional blood flow impairment.

OBJECTIVES

The aim of the study was to analyze whether Ex-tcpO2 could serve as a non-invasive technique for detecting ischemia resulting from PAES.

METHODS

Patients with suspected PAES were recruited between 2017 and 2020. The diagnosis was confirmed or rejected, according to the surgical decision based on our diagnosis management involving a multidisciplinary team. Each patient underwent Ex-tcpO2 with specific maneuvers. The decrease from rest of oxygen pressure (DROP) index served for the interpretation of exercise results.

RESULTS

Sixty-five legs with suspected PAES were recruited. Diagnosis was confirmed in 34 (52.3%) and rejected in 32 (47.7%). The average DROP values found in confirmed and rejected group at left leg were - 21.6 ± 15.4 mmHg and - 10.9 ± 11.1 mmHg, respectively (p for Mann-Whitney 0.004), and - 15.8 ± 11 mmHg and - 11.1 ± 7.5 mmHg, respectively, at right leg (p = 0.088). Ex-tcpO2 sensitivity and specificity were 52.9% and 78.1%, respectively.

CONCLUSION

Ex-tcpO2 is an original non-invasive investigation for patients with claudication of doubtful arterial origin. The sensitivity and specificity are 52.9% and 78.1% in functional PAES diagnosis using 15 mmHg as threshold to detect ischemia during tiptoeing elevations.

Popliteal Artery Entrapment Syndrome: Updates for Evaluation, Diagnosis, and Treatment

ABSTRACT

Popliteal artery entrapment syndrome remains difficult to diagnose. Meanwhile, our limited knowledge and understanding make treatment decisions complex. The list of differential diagnoses for exertional leg pain is broad. Oftentimes, patients exhibit confounding and coexisting diagnoses. However, accurate and rapid diagnosis of popliteal artery entrapment syndrome is essential to reduce potential lasting damage to the popliteal artery. A combination of clinical history, physical examination, ankle-brachial index, along with dynamic and static imaging such as duplex ultrasound, computed tomography angiogram, and magnetic resonance angiography, aids diagnosis. Surgical treatment may be definitive depending on the type of popliteal artery entrapment syndrome, but there have been recent advances in diagnostics with intravascular ultrasound and nonsurgical treatment with botulinum toxin type A. Further research is needed to standardize diagnostic criteria, uncover innovative diagnostic methods, and validate promising nonoperative treatment options.

Staged bilateral release of the popliteus muscle using a posterior surgical approach to the popliteal fossa to treat type 4 popliteal artery entrapment

Popliteal artery entrapment syndrome (PAES) is a rare cause of intermittent claudication in the young. Aberrant embryological development results in entrapment of the popliteal artery by myofascial structures of the popliteal fossa. Type 4 PAES is due to aberrant development of the popliteus muscle superficial to the popliteal artery. We present a case of bilateral type 4 PAES, along with intraoperative photography highlighting the anatomical cause for this pathology. Both limbs in this patient were treated successfully with surgical release of the entrapping popliteus muscle via a posterior surgical approach to the popliteal fossa. This report emphasises the importance of determining popliteal artery integrity and entrapment subtype to guide the management of this condition.

Surgical Treatment and Rehabilitation of Bilateral Popliteal Artery Entrapment Syndrome in a Young Boxer: A Case Report

Popliteal artery entrapment syndrome, a rare vascular disease observed in young athletes, is characterized by intermittent claudication and is often overlooked by orthopedists. Popliteal artery entrapment syndrome should be treated promptly when diagnosed, as the vascular lesion can progress. We present a case of bilateral popliteal artery entrapment syndrome in a young professional boxer with no significant family or past medical history. He had developed intermittent claudication during a boxing match with pain in both calves, making it impossible for him to continue for more than three rounds. He was diagnosed with popliteal artery entrapment syndrome, and surgery treatment with reconstruction of the medial gastrocnemius muscle to maintain muscle strength was performed in collaboration with a cardiovascular surgeon. Then, he underwent rehabilitation according to postoperative treatment for gastrocnemius muscle rupture, and finally, he could return to professional boxing matches with victory. PAES is often initially overlooked by orthopedic surgeons. This is the first report of functional reconstruction surgery and effective rehabilitation performed for PAES. This case focuses on the early diagnosis of and proper orthopedic approach to popliteal artery entrapment syndrome, which is considered important to enable patients to return to high-level sports.

Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome

BACKGROUND

Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long-term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long-term physical activity return after surgery with the Tegner activity scale.

METHODS

All patients who underwent surgery for fPAES from January 1, 2010, to December 31, 2020, were searched. After ethical approval, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: "before symptoms," "before surgery," and "after surgery."

RESULTS

Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6 ± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3), and the median score at the time of the phone call "after surgery" was 5 (3-7). P value was <0.0001 by comparing results "before surgery" and "after surgery."

CONCLUSIONS

Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.

Popliteal Artery Entrapment Syndrome Presented with Popliteal Artery Pseudoaneurysm: A Case Report

Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder characterized by the compression of the popliteal artery behind the knee, primarily affecting physically active individuals. This is a case of a 36-year-old man who presented with a 1-week history of sudden-onset left leg pain. Diagnostic evaluation, including physical examination, color duplex ultrasonography, computed tomography, and magnetic resonance imaging, revealed a popliteal artery pseudoaneurysm caused by type 5 PAES. The patient underwent surgical exploration to release the entrapment, followed by an interposition graft with the ipsilateral great saphenous vein. Patient postoperative recovery was uneventful, with significant symptomatic improvement. This case underscores the significance of considering PAES as a differential diagnosis in young patients with popliteal artery aneurysms and highlights the necessity for prompt diagnosis and treatment to prevent limb-threatening complications.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee

ABSTRACT

In this dynamic scanning protocol, ultrasound examination of the knee is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of the daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.