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Objective
Functional popliteal entrapment (FPE) is a rare, but disabling condition in young patients that limits performance. We developed a highly specialized algorithm for the workup, diagnosis, and operative technique that involves provocative CT-A and debulking of a specific portion of the medial head of the gastrocnemius muscle.
Methods
21 (62% female) high performance athletes (11 runners, 2 triathletes, 2 soccer players, 2 lacrosse players, 1 basketball player, 1 gymnast, 1 diver, and 1 high jumper) unable to compete due to claudication were evaluated with a unique CT-A protocol with provocative maneuvers. All patients underwent posterior approach operative mobilization of the popliteal artery, and debulking of the antero-lateral quadrant of the medial gastrocnemius muscle to alleviate compression of the artery onto the lateral femoral condyle.
Results
Of the 21 patients treated, 9 had bilateral symptoms (43%), and all 30 popliteal arteries demonstrated obliteration on CT-A with provocative maneuvers. All resting ABIs were normal, but only 42% had abnormal exercise ABIs. Popliteal artery mobilization and debulking of the medial gastrocnemius (mean 7.6 cm3 muscle removal) was performed in all patients. One patient had a postoperative seroma (3%), and all resting ABIs remained normal. During a mean followup of 9 months, 100% of patients had resolution of short distance claudication. 20% of the patients developed some degree of recurrent symptoms, and 53% returned to prior competitive levels.
Conclusions
In patients with FPE, CT-A with provocative maneuvers can guide surgical intervention, which involves debulking of the hypertrophied antero-lateral quadrant of the medial gastrocnemius muscle. Functional outcomes in high performance athletes are adequate, and in the majority of patients provides improved pain-free walking capacity and ability to return to full competitive sport.