Popliteal entrapment syndrome. A systematic review of the literature and case presentation

Abstract

Popliteal artery entrapment syndrome (PAES) is rare in young adults. Claudication of the young patient, which is often overlooked, is a very rare symptom for orthopedic surgeons. In elder patients, the physician might expect atherosclerotic claudication, however in young patients, popliteal artery entrapment syndrome (PAES) should be considered as a possibility in the cases of claudication. Here, an unusual presentation of an uncommon disease that is not widely known by orthopedic surgeons is reported.

Keywords: circulation; contact sports; lower limb surgery; muscles; popliteal artery; tendons.

Figure 1a.

Pre operative - MRI angiography: the arrows show stenotic segment clearly. Notice the decreased blood flow at distal cruris.

Figure 1b.

Arrow 1: popliteal artery stenotic segment; Arrow 2: post stenotic aneurysm and thrombus.

Figure 2a.

Ct angiography: 1,2,3,4 numerics show abundant collateral arteries, right popliteal artery is normal. Ω, α, β represent distal occlusions due to micro embolism. The arrow shows stenotic segment.

Figure 2b.

Post operative angiography; Arrow a shows foot print of previous stenotic segment that totally resolved. Arrow c shows one branch of the trificutaio still occlused but collateral circulation established (Arrow d); Arrow b shows unaffected side.

Figure 3a.

Arrow a shows abnormal musculotendinous insertion of the medial gastrocnemius head. (Type 3), Arrow b shows medial gastrocnemius medial head.

Figure 3b.

Omega represents abnormal muscular part of the insertion, originating from medial head of gastrocnemius; Asterisk represents the abnormal fibrous sheat that lies under the abnormal musculotendinous insertion. Notice the post stenotic aneurysm. Alpha represents gastocnemius lateral muscle mass hypertrophy and beta represents detached and retracted medial head.