Anatomic popliteal entrapment syndrome is often a difficult diagnosis.

Anatomic popliteal artery entrapment can be challenging to diagnose. Four cases are described in which initial diagnosis and treatment failed to identify and correct the anatomic defect responsible for patients' symptoms. In 3 of these cases, initial assessment and diagnosis was exertional compartment syndrome, yet compartment release did not resolve the complaint. Following accurate diagnosis, surgical release of aberrant popliteal fossa anatomy provided all 4 patients with lasting symptom resolution, though 1 patient with bilateral operations has had relief of only 1 side. In the diagnostic algorithm for these patients, angiography with forced plantarflexion against resistance aids in eliciting the pathognomonic images of arterial occlusion in this disorder.