Popliteal entrapment syndrome

Introduction: Popliteal entrapment syndrome (PES) is a rare but important cause of intermittent claudication in young people. Controversy exists about optimal strategies for diagnosis and management, particularly for variants such as functional popliteal entrapment. The aim of this review was to systematically catalog the published English-language literature on PES and to determine if evidence-based guidelines for management could be formulated.

Methods: An electronic search using the MEDLINE, EMBASE, Cochrane Library, AMED, and CINAHL databases was performed to identify articles about PES published from 1947 to December 2010. The systematic review conformed to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement standards. Prospective studies and retrospective case series with more than five patients with arterial, venous, nerve, and combined neurovascular entrapment were analyzed on a study-by-study narrative basis.

Results: The search identified 291 articles, and 44 were included. Of these, 30 studies were on popliteal artery entrapment syndrome (PAES). No relationship was found between duration of symptoms and the presence of irreversible arterial injury. Each study used a median of three diagnostic tests (range, 1-6). Arteriography was used in 28 of 30 studies to diagnose PAES, with an estimated mean sensitivity of 97% (range, 85%-100%). Twenty-three studies described arterial reconstructive procedures, with a median failure rate of 27.5% (range, 0%-83%). The proportion of patients asymptomatic after surgery was reported in only 12 of 30 studies, with a median value of 77% (range, 70%-100%).

Conclusions: A large volume of predominantly retrospective clinical data exists on PES. A subset of studies describe a significant failure rate after surgery, but study quality is insufficient to derive robust conclusions allowing recommendation of any one particular diagnostic modality or operative procedure over another. Improvements in management of this condition are unlikely to result from publication of further retrospective case series, and clinicians should concentrate on prospectively collected data with predefined inclusion criteria, outcome measures, follow-up protocols, and transparent standardized reporting criteria.