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1405 - Adventitial Cystic Disease Resulting in Foot Drop in a D1 Wrestler

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

EB

Evan Banks, MD

Resident
University of Minnesota
Minneapolis, Minnesota, United States

Co-Author(s)

ES

Eli Schmidt, MD, MS

Resident
University of Minnesota
Minneapolis, Minnesota, United States

Corresponding Author(s)

MG

Mahmood Gharib, MD

Assistant Professor
University of Minnesota
Minneapolis, Minnesota, United States

Case Diagnosis: Foot Drop Secondary to Resection of Popliteal Adventitial Cyst Disease

Case Description: A 22-year-old Division I collegiate wrestler presented to an outpatient clinic with chronic left leg weakness, tightness, and burning from the mid-lateral calf to the dorsum of the foot, with no history of acute injury. Initial evaluations including physical exam, MRI of the left knee and lumbar spine, and EMG, were unremarkable, leading to a diagnosis of exertional compartment syndrome. One year later, persistent pain in the peroneal nerve distribution prompted a repeat MRI, which revealed a multiloculated cystic lesion along the popliteal artery, consistent with adventitial cystic disease (ACD). The patient underwent resection with interposition grafting of the left great saphenous vein. Post-operatively, he experienced increased numbness and weakness in dorsiflexion. Repeat EMG was abnormal with low compound muscle action potential for the peroneal nerve. With physical therapy, he achieved dorsiflexion against gravity five months post-procedure and returned to collegiate wrestling at eight months.

Discussions: Adventitial cystic disease (ACD) is a rare, non-atherosclerotic vascular disorder comprising just 0.1% of all vascular diseases. ACD is characterized by a cystic mass in the subadventitial layer of the artery, commonly the popliteal artery, causing arterial occlusion and claudication symptoms. Diagnosis is typically made via ultrasound, CT, MRI, or angiography. Treatment depends on symptom severity and may involve conservative management, aspiration with or without a sclerosant, or surgical resection. The patient had no palpable masses, no atherosclerotic risk factors, and intact pulses, making ACD the most likely diagnosis.

Conclusions: Due to profound peroneal nerve palsy following surgical resection of the cystic mass within the popliteal artery, we suspect this cyst unexpectedly contained peroneal nerve fibers, which complicated this patient's recovery. Therefore, it is important to raise awareness among surgeons and physiatrists about the complications associated with treatment of this condition to prepare patients for recovery.