What is it?

Popliteal Artery Entrapment Syndrome (PAES) is an uncommon vascular condition that affects the legs, most often in younger male athletes. The popliteal artery is located behind the knee and is the main blood supply to the lower leg.

In athletes with PAES, the popliteal artery becomes compressed by the surrounding calf muscles or tendons. This occurs as the result of the popliteal artery or calf muscles developing too close to each other as they grow. Compression of the popliteal artery decreases the blood supply to the lower leg, which over time can result in permanent vascular damage. In athletes predisposed to PAES, exercise leads to enlargement of these muscles and increases the chance of artery compression, which can result in leg pain and other symptoms.

Symptoms

Symptoms of PAES may include:

• Leg swelling

• Calf cramping

• Muscle fatigue

• Foot numbness and tingling

These symptoms usually occur predictably during activity and resolve with rest.

Sports Medicine Evaluation & Treatment

A sports medicine physician will carefully review the symptoms, and examine the leg for swelling, coolness and decreased sensation. The physician will also check for pulses in the foot and ankle. In PAES, pulses are commonly felt at rest, but will become more difficult to identify with exercise or when the foot is moved up/down. Based on the evaluation findings, the physician may recommend testing to evaluate the blood flow below the knee. Further testing may include ankle brachial pressures with exercise, duplex ultrasonography, computed tomographic angiography (CTA) or magnetic resonance angiography (MRA).

Treatment for PAES is usually surgical and involves consultation with a surgeon (vascular surgeon) who specializes in blood vessels. Surgery is done to release the popliteal artery from the muscles compressing it. In cases where the artery has become blocked, the surgeon will bypass the affected area, as well as correct any muscular issues.

Prevention

Because PAES is related to how the popliteal artery and surrounding muscles develop as we are born and grow older, it cannot be prevented. Being aware of this syndrome is crucial for the early diagnosis and prevention of disease progression.

Return to Play

If a surgical procedure is performed, return to play will depend on many factors including individual recovery. After surgery, most athletes can start non-impact aerobics at one week, followed by advancement of activity around four weeks. Repeat testing to assess blood supply will also be done. After completion of a formal rehabilitation program, athletes can resume full participation.

AMSSM Member Authors
Jason Krystofiak, MD and Kristina Quirolgico, MD

References
Hameed M, Coupland A, Davies AH. Popliteal artery entrapment syndrome: an approach to diagnosis and management. Br J Sports Med Published Online First: 19 January 2018. doi: 10.1136/bjsports-2017-098704.
Turnipseed, W. Functional popliteal artery entrapment syndrome: a poorly understood and often missed diagnosis that is freqeunly mistreated. Journal of Vascular Surgery 2009;49(5):1189-1195.