Rare Cause of Foot Drop in a Division 1 Wrestler

Area of Science:

• Vascular Surgery
• Orthopedic Surgery
• Diagnostic Imaging

Background:

• Adventitial cystic disease (ACD) is a rare, non-atherosclerotic condition causing stenosis or occlusion of arteries due to mucoid degeneration of the vessel wall.
• ACD commonly affects the popliteal artery and can present with chronic limb ischemia, mimicking other conditions like exertional compartment syndrome.
• This case highlights a young athlete with chronic leg and foot symptoms initially misdiagnosed, emphasizing the need for thorough evaluation.

Purpose of the Study:

• To report a clinical case of adventitial cystic disease in a collegiate athlete.
• To emphasize the diagnostic challenges and potential complications of ACD, including neural involvement.
• To underscore the importance of advanced imaging and electrodiagnostic studies in the preoperative assessment of ACD.

Main Methods:

• Case report of a 22-year-old collegiate wrestler with chronic left foot and ankle symptoms.
• Review of serial magnetic resonance imaging (MRI) findings, initially of the knee and later revealing a popliteal artery cystic lesion.
• Surgical resection of the adventitial cyst and postoperative assessment of neurological function.

Main Results:

• Initial diagnosis of exertional compartment syndrome was revised to adventitial cystic disease after repeat MRI revealed a multiloculated cystic lesion.
• Surgical resection of the cyst led to worsening dorsiflexion weakness, suggesting intra-articular extension and common peroneal nerve involvement.
• The patient experienced foot drop, a potential complication of ACD progression and surgical intervention.

Conclusions:

• Adventitial cystic disease can present insidiously with symptoms mimicking other conditions, particularly in athletes.
• High-resolution imaging (MRI) and electromyography (EMG) are essential for preoperative assessment of intra-articular and neural involvement.
• Patient counseling regarding the risk of foot drop is critical due to potential nerve compromise from ACD and surgery.