ACSM FPAES abstract
TLevel of evidence: IV Objective: To evaluate the work up and outcomes of athletes with exertional leg pain, specifically the co-existence of functional popliteal artery entrapment syndrome (FPAES) and chronic exertional compartment syndrome (CECS), in athletes who were unable to return to sport or have significant symptomatic improvement after lower leg compartment fasciotomy. Design: Retrospective case series Setting: Outpatient musculoskeletal sports clinic, outpatient vascular surgery clinic Participants: 36 patients aged 15-67 (average age 26.9) diagnosed with functional popliteal artery entrapment syndrome using CT-angiogram with provocative maneuvers or MRI-angiogram with provocative maneuvers. In our cohort, a moderate number of athletes (11/36 athletes, 19/59 affected limbs) were referred for evaluation by vascular surgery after already having undergone lower leg fasciotomies for chronic exertional compartment syndrome. Interventions:Partial debulking of anterolateral quadrant of the medial head of the gastrocnemius muscle with or without fasciotomy Main Outcome Measures:Return to sport/previous activities Results:Mean follow up was 52.3 ± 22.2 months. 78% (28/36) of the patients were able to fully return to their previous athletic competitive levels. All patients were able to resume their athletic sport at a recreational level. The patients participated in a myriad of sports and athletic activities: 14 runners, 9 soccer players, 3 unspecified, 2 lacrosse, 2 basketball, 1 triathlete, 1 jumper, 1 diver, 1 water polo, 1 rugby, 1 skier. At 6-month follow-up, there were 13% of affected limbs that had recurrent symptoms, at 12 months, only 5% had recurrent symptoms and at three years, no patients had symptoms present.
Conclusions:Many of these patients were unable to return to participate in high levels at their respective sport even after initial fasciotomy for CECS, suggesting that FPAES was unidentified, overlooked, or
possibly developed after fasciotomy. FPAES can be a co-existing diagnosis that warrants screening during the evaluation of CECS. Provocative CT-A and MRI-A protocols can help guide the diagnosis as well as location of muscle debulking to alleviate the functional entrapment that occurs in these athletes with exercise. It is important to consider and screen for this diagnosis to allow for proper treatment and return to sport.