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Diagnosis and surgical treatment of popliteal artery entrapment syndrome in elite athletes
ESSKA Academy. Lopez-Vidriero Tejedor R. Nov 9, 2019; 286402
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Diagnosis and surgical treatment of popliteal artery entrapment syndrome in elite athletes

ESMA Free Papers

Topic: Sports Injury and Return to Competition Criteria

Lopez-Vidriero Tejedor R.1, Lopez-Vidriero Tejedor E.2
1ISMEC, Madrid, Spain, 2ISMEC, Seville, Spain

Introduction: Recurrent calf pain is a cause of disability in athletes. Muscle cramps or muscle tears may be a cause of misdiagnosis of Popliteal Artery Entrapment Syndrome (PAES). There are essentially five anatomic variants of PAES; more recently, a 'functional' PAES has been described in patients with normal anatomy (type VI). In such cases, compression of the popliteal artery may be due to an anatomically normal but hypertrophic muscle. This entity is usually seen in well-conditioned athletes, sometimes during the anabolic muscle development adolescent stage, coinciding with intensive training and muscle hypertrophy.
Objetives: Show the results after surgical decompression of PAES in elite athletes.
Aim: Highlight the importance of PAES diagnose and treatment
Methods: 6 cases of PAES are reported in a cohort of 4 high-level athletes: 3 professional soccer players and 1 professional tennis player. 2 cases were bilateral. N=6. Mean age at diagnosis 25+/-5 years old. Diagnosis was made by clinical symptoms: recurrent calf pain on exercise, that was compatible with intermittent vascular claudication; dynamic ultrasound and dynamic angioCT and/or MRI angiography were obtained. Surgical decompression by removing the aberrant belly compressing the popliteal artery was performed. Main variables of the study: time return to sports in months, type of entrapment, time until beginning of pain with heel rises and SF 36 before surgery and at 1 year postop. Statistical analysis with SPSS
Results: Time to return to sports: mean time was 3+/- 2 months. Type of entrapment: all cases showed an anomalous band arising from the medial gastrocnemius head (Type III), and case 3 showed also a functional component (Type VI) with a "double crush" of the artery. Time until beginning of pain with heel rises: preop: 50+/- 25 sec postop: no pain but fatigue 150+/-30 sec p< 0.05 SF 36 preop: 80.48; postop: 96.25. p< 0.05. All the athletes returned to their previous level of performance or better.
Conclusions: PAES is uncommon and difficult to diagnose. Awareness of the entity is a prerequisite for correct diagnosis, and should be suspected in young athletes who present with repetitive calf pain and claudication. Surgical treatment is successful in returning athletes to their previous or better level of competition without calf pain and improves their quality of life if the condition is diagnosed before there are intimal vessel damages.
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