title: Functional popliteal entrapment syndrome in the sportsperson.
abstract: OBJECTIVE
  To define the clinical syndrome of functional popliteal entrapment comparing pre and post surgical clinical outcomes with pre and post-operative provocative ultrasonic investigations. Further, to suggest a management pathway to differentiate chronic exertional compartment syndromes and concomitant venous popliteal compression.
  
  
  METHODS
  In 32 claudicant sportspersons, 55 limbs were characterised pre-surgery clinically, with provocative testing including hopping, and following a series of non-invasive tests. The clinical findings, ankle brachial indices (ABI) and duplex outcomes were compared pre-operatively, at 3 months post-operatively (n = 52) and in the long term i.e. 16 months (n = 17).
  
  
  RESULTS
  At 3 months, all 55 limbs had clinical follow up. 52 of the 55 limbs had follow up with ultrasound with provocative manoeuvres. The ABIs normalised in 46 (88%). There were 40 of 52 (76%) that became asymptomatic post surgery with a normal scan. There were 4 of 52 (8%) who were clinically asymptomatic but with residual obstruction on duplex and who were able to resume their usual lifestyle. There were 4 (8%) that had abnormal findings both on post-operative scan and clinically. Re-operation on 2 limbs corrected the duplex findings and the symptoms. There were 4 (8%) limbs that had normal duplexes but continued with symptoms albeit varied from the presenting symptoms. In the longer term, a further 2 became symptomatic at 2.8 years requiring a further successful intervention. (Concomitant popliteal venous obstruction was present in 5 limbs (10%) on standing.)
  
  
  CONCLUSIONS
  In the claudicating sportsperson, where there are no well characterised specific anatomical abnormalities, the syndrome can be characterised by provocative clinical (particularly hopping) and non-invasive tests. A positive clinical outcome with surgery can be predicted by abnormal pre-surgical ultrasonic investigations and confirmed later by a similar normal post surgical study. Concomitant venous compression may occur while standing with both syndromes related to muscle hypertrophy.
authors: Dalcross Adventist Hospital, Sydney, New South Wales, Australia. rodlane@vsim.com.au
authors: R
authors: R
authors: Lane
authors: T
authors: T
authors: Nguyen
authors: M
authors: M
authors: Cuzzilla
authors: D
authors: D
authors: Oomens
authors: W
authors: W
authors: Mohabbat
authors: S
authors: S
authors: Hazelton
mesh_terms: D000328:Adult; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001265:Athletic Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D006984:Hypertrophy; D018810:Magnetic Resonance Angiography; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology / Q000601:surgery; D009517:New South Wales; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult