Rare Cause of Foot Drop in a Division 1 Wrestler

In this clinical vignette, we report the case of a 22-yr-old division I collegiate wrestler who presented with chronic left foot and ankle weakness, tightness, and a burning sensation extending from the midlateral calf to the dorsum of the foot. Initial magnetic resonance imaging completed of the left knee 1 yr before presentation was unremarkable. He was given a diagnosis of exertional compartment syndrome and he was medically cleared to compete. However, after sustaining an unrelated left knee injury during a match 4 wks later, a repeat magnetic resonance imaging revealed a multiloculated cystic lesion along the popliteal artery, consistent with adventitial cystic disease. The patient underwent surgical resection of the cyst and had worsening dorsiflexion weakness following the procedure. This was despite careful intraoperative preservation of the common peroneal nerve, suggesting the rare occurrence of intraarticular extension and possible nerve involvement. This case highlights the complex nature of adventitial cystic disease, drawing parallels to intraneural ganglion cysts. We detail the importance of early recognition through high-resolution imaging and electromyography to assess for intraarticular and neural involvement preoperatively. Additionally, patient counseling should address the potential risk of foot drop as a complication of both adventitial cystic disease progression and surgical intervention.