Abstract
Similar to other peripheral artery diseases, vessel narrowing in popliteal artery entrapment syndrome (PAES) reduces the ankle brachial index (ABI). Since the PAES is related to several anatomical or functional variations, we sought to determine if the ABI was correlated with the type of syndrome. Through a systematic review of literature, we identified case reports and series in which the diagnosis of PAES was accompanied by ABI measurement. Twenty-seven studies included in the qualitative synthesis described 87 limbs. The most common types of the syndrome were those caused by an abnormal medial head of the gastrocnemius (type II, n = 35, 40.23%) and aberrant course of the popliteal artery (type I, n = 20, 22.99%). The variation of plantaris muscle (n = 7, 8.05%) is currently not included in the classification system. The median value of ABI was 0.87 (interquartile range (IQR) = 0.6–1.0). There were no differences among types of syndrome (F = 0.13, p = 0.72). In conclusion, despite clinical recommendations, the ABI remains underused in PAES diagnosis. No correlation was detected between the index score and type of syndrome. The cases of PAES involving structures other than the gastrocnemius or popliteus muscle suggest the need to revisit the current clinical classification system.
Highlights
Musculoskeletal injury is the most common cause of pain and dysfunction among sports participants, in young males [1]
Taking into account the variations in its anatomical and clinical presentation, we investigated the relation between ankle brachial index (ABI) score and popliteal artery entrapment syndrome (PAES) type, aiming at providing two diagnostic cues: first, whether a particular type of PAES presents with lower ABI, and higher severity, at diagnosis than the others; and second, whether the ABI score can aid in predicting the type of PAES
The current analysis of a series of case reports did not find any evidence that ABI score was correlated with the type of PAES
Summary
Musculoskeletal injury is the most common cause of pain and dysfunction among sports participants, in young males [1]. A widely accepted and currently used classification of PAES was proposed by Love and Whelan [16] and modified by Rich et al [17] According to this system, type I is associated with an aberrant medial arterial course around the normal medial head of the gastrocnemius muscle. Taking into account the variations in its anatomical and clinical presentation, we investigated the relation between ABI score and PAES type, aiming at providing two diagnostic cues: first, whether a particular type of PAES presents with lower ABI, and higher severity, at diagnosis than the others; and second, whether the ABI score can aid in predicting the type of PAES To this end, we examined the relationship between the anatomical variation causing PAES and the ABI score. Through a systematic review of case reports and case series, our study sheds new light on the anatomical abnormalities causing PAES, indicating a need to revisit the current classification system
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