Kneeling-induced calf ischemia: a pilot study in apparently healthy European young subjects.
Lower limb
Occupational diseases
Oxygen pressure
Positional disease
Sports
Transcutaneous oximetry
Journal
European journal of applied physiology
ISSN: 1439-6327
Titre abrégé: Eur J Appl Physiol
Pays: Germany
ID NLM: 100954790
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
28
10
2020
accepted:
02
07
2021
pubmed:
14
7
2021
medline:
1
2
2022
entrez:
13
7
2021
Statut:
ppublish
Résumé
Many tasks, sports or leisure activities require maximal knee flexion. We hypothesized that this position could result in reduced calf perfusion, in young European subjects. We quantified calf ischemia resulting from the knee flexion with transcutaneous oxygen pressure (TcpO2) sensors by assessing the decrease from rest of TcpO2 (DROP) defined as limb changes minus chest changes. A minimal DROP (DROPm) <-15 mmHg defines the presence of ischemia. From the crawling position, participants kneeled for 3 min while bending as in prostration/prayer position (P). Thirty-five participants repeated this maneuver a second time, while 7 participants were also required to sit on their heels with the torso in the vertical position to attain knee flexion without significant groin flexion (S). In 41 healthy young volunteers (30 males), 25 [20-31] years old, 37 patients showed a DROPm < -15 mmHg from "R" to "P" in one (n = 4) or both (n = 33) calves (90.2%; 95% CI 76.9-97.3). After backward regression of the DROPm, there was no significant association with side, body weight of systolic blood pressure. However, age was strongly associated with DROPm (OR 5.34 [2.45-8.69]) so that DROPm was significantly higher in older, with a correlation ρ = 0.31 (p = 0.003). Kneeling dramatically reduces calf perfusion, likely through popliteal artery kinking, possibly through muscle crushing. Eastern lifestyle includes routine flexed position since childhood. Whether or not such a chronic training reduces the risk of kneeling-induced ischemia in adults is unknown to date.
Identifiants
pubmed: 34254181
doi: 10.1007/s00421-021-04764-8
pii: 10.1007/s00421-021-04764-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3031-3040Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Abraham P, Leftheriotis G, Bourre Y, Chevalier JM, Saumet JL (1993) Echography of external iliac artery endofibrosis in cyclists. Am J Sports Med 21(6):861–863
doi: 10.1177/036354659302100618
Abraham P, Gu Y, Guo L, Kroeger K, Ouedraogo N, Wennberg P, Henni S (2018) Clinical application of transcutaneous oxygen pressure measurements during exercise. Atherosclerosis 276:117–123. https://doi.org/10.1016/j.atherosclerosis.2018.07.023
doi: 10.1016/j.atherosclerosis.2018.07.023
pubmed: 30059842
Abraham P, Ramondou P, Hersant J, Sempore WY, Feuilloy M, Henni S (2020) Investigation of arterial claudication with transcutaneous oxygen pres. Trends Cardiovasc Med. https://doi.org/10.1016/j.tcm.2020.03.003
doi: 10.1016/j.tcm.2020.03.003
pubmed: 32234333
Abrahamsen SO, Stilling M (2013) Life-threatening rhabdomyolysis after prolonged hypoperfusion of the lower legs. BMJ Case Rep. https://doi.org/10.1136/bcr-2012-008305
doi: 10.1136/bcr-2012-008305
pubmed: 23696137
pmcid: 3669799
Ballesteros R, Garc A-L, Zaro FJ, Moreno J, Chac NM, Laga O, Lee M (2009) Bilateral leg compartment syndrome complicating prolonged spine surgery in the kneeling position. Sch Res Exch. https://doi.org/10.3814/2009/535178
doi: 10.3814/2009/535178
Biswas S, Roa R, Duckworth A, Kothuru R, Florzes L, Abrol S (2013) Atraumatic compartment syndrome of the legs leading to rhabdomyolysis and acute renal failure following prolonged kneeling in a heroin addict. J Trauma Critical Care Emerg Surg 2(3):139–145
Budd JS, Brennan J, Beard JD, Warren H, Burton PR, Bell PR (1990) Infrainguinal bypass surgery: factors determining late graft patency. Br J Surg 77(12):1382–1387
doi: 10.1002/bjs.1800771220
Chakfe N, Jahn C, Nicolini P, Kretz JG, Edah-Tally S, Beaufigeau M, Lebras Y, Beaujeux R, Durand B, Eisenmann B (1997) The impact of knee joint flexion on infrainguinal vascular grafts: an angiographic study. Eur J Vasc Endovasc Surg 13(1):23–30
doi: 10.1016/S1078-5884(97)80046-9
Cheng CP, Wilson NM, Hallett RL, Herfkens RJ, Taylor CA (2006) In vivo MR angiographic quantification of axial and twisting deformations of the superficial femoral artery resulting from maximum hip and knee flexion. J Vasc Interv Radiol 17(6):979–987. https://doi.org/10.1097/01.RVI.0000220367.62137.e8
doi: 10.1097/01.RVI.0000220367.62137.e8
pubmed: 16778231
Crichlow RW, Roberts B (1966) Treatment of popliteal aneurysms by restoration of continuity: review of 48 cases. Ann Surg 163(3):417–426. https://doi.org/10.1097/00000658-196603000-00015
doi: 10.1097/00000658-196603000-00015
pubmed: 5907567
pmcid: 1476892
Desyatova A, MacTaggart J, Romarowski R, Poulson W, Conti M, Kamenskiy A (2018) Effect of aging on mechanical stresses, deformations, and hemodynamics in human femoropopliteal artery due to limb flexion. Biomech Model Mechanobiol 17(1):181–189. https://doi.org/10.1007/s10237-017-0953-z
doi: 10.1007/s10237-017-0953-z
pubmed: 28815378
Drey IA, Baruch H (2008) Acute compartment syndrome of the calf presenting after prolonged decubitus position. Orthopedics 31(2):184
doi: 10.3928/01477447-20080201-08
Dulay GS, Cooper C, Dennison EM (2015) Knee pain, knee injury, knee osteoarthritis & work. Best Pract Res Clin Rheumatol 29(3):454–461. https://doi.org/10.1016/j.berh.2015.05.005
doi: 10.1016/j.berh.2015.05.005
pubmed: 26612241
Ehsan O, Darwish A, Edmundson C, Mills V, Al-Khaffaf H (2004) Non-traumatic lower limb vascular complications in endurance athletes. Review of literature. Eur J Vasc Endovasc Surg 28(1):1–8. https://doi.org/10.1016/j.ejvs.2004.02.002
doi: 10.1016/j.ejvs.2004.02.002
pubmed: 15177226
Eifell R, Mudawi A (2007) A simple technique to prevent graft kinking during tunneling of a reversed vein femoropopliteal bypass graft. Surg Today 37(4):356–358. https://doi.org/10.1007/s00595-006-3337-z
doi: 10.1007/s00595-006-3337-z
pubmed: 17387575
Erdoes LS, Devine JJ, Bernhard VM, Baker MR, Berman SS, Hunter GC (1994) Popliteal vascular compression in a normal population. J Vasc Surg 20(6):978–986
doi: 10.1016/0741-5214(94)90236-4
Fujiwara H, Sugano T, Fujii N (1992) Popliteal artery entrapment syndrome: accurate morphological diagnosis utilizing MRI. J Cardiovasc Surg (torino) 33(2):160–162
Gadbois JA, McMullan JT (2016) prolonged kneeling: why can’t your patient get up from a kneeling position? JEMS 41(12):14–15
pubmed: 29206014
Gokgol C, Schumann S, Diehm N, Zheng G, Buchler P (2017) In vivo quantification of the deformations of the femoropopliteal segment: percutaneous transluminal angioplasty vs nitinol stent placement. J Endovasc Ther 24(1):27–34. https://doi.org/10.1177/1526602816677530
doi: 10.1177/1526602816677530
pubmed: 28095767
Haertsch PA (1981) The blood supply to the skin of the leg: a post-mortem investigation. Br J Plast Surg 34(4):470–477. https://doi.org/10.1016/0007-1226(81)90061-8
doi: 10.1016/0007-1226(81)90061-8
pubmed: 7296154
Hicks CW, Black JH 3rd, Ratchford EV (2019) Popliteal artery entrapment syndrome. Vasc Med 24(2):190–194. https://doi.org/10.1177/1358863X18822750
doi: 10.1177/1358863X18822750
pubmed: 30739583
Hulshof CTJ, Colosio C, Daams JG, Ivanov ID, Prakash KC, Kuijer P, Leppink N, Mandic-Rajcevic S, Masci F, van der Molen HF, Neupane S, Nygard CH, Oakman J, Pega F, Proper K, Pruss-Ustun AM, Ujita Y, Frings-Dresen MHW (2019) WHO/ILO work-related burden of disease and injury: protocol for systematic reviews of exposure to occupational ergonomic risk factors and of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases. Environ Int 125:554–566. https://doi.org/10.1016/j.envint.2018.09.053
doi: 10.1016/j.envint.2018.09.053
pubmed: 30583853
pmcid: 7794864
Kamenskiy AV, Pipinos II, Dzenis YA, Phillips NY, Desyatova AS, Kitson J, Bowen R, MacTaggart JN (2015) Effects of age on the physiological and mechanical characteristics of human femoropopliteal arteries. Acta Biomater 11:304–313. https://doi.org/10.1016/j.actbio.2014.09.050
doi: 10.1016/j.actbio.2014.09.050
pubmed: 25301303
Learoyd BM, Taylor MG (1966) Alterations with age in the viscoelastic properties of human arterial walls. Circ Res 18(3):278–292
doi: 10.1161/01.RES.18.3.278
MacTaggart JN, Phillips NY, Lomneth CS, Pipinos II, Bowen R, Baxter BT, Johanning J, Longo GM, Desyatova AS, Moulton MJ, Dzenis YA, Kamenskiy AV (2014) Three-dimensional bending, torsion and axial compression of the femoropopliteal artery during limb flexion. J Biomech 47(10):2249–2256. https://doi.org/10.1016/j.jbiomech.2014.04.053
doi: 10.1016/j.jbiomech.2014.04.053
pubmed: 24856888
McCully KK (2010) The influence of passive stretch on muscle oxygen saturation. Adv Exp Med Biol 662:317–322. https://doi.org/10.1007/978-1-4419-1241-1_45
doi: 10.1007/978-1-4419-1241-1_45
pubmed: 20204809
Mozersky DJ, Sumner DS, Hokanson DE, Strandness DE Jr (1972) Transcutaneous measurement of the elastic properties of the human femoral artery. Circulation 46(5):948–955. https://doi.org/10.1161/01.cir.46.5.948
doi: 10.1161/01.cir.46.5.948
pubmed: 5081146
Ninomiya JT, Dean JC, Goldberg VM (1999) Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplasty 14(7):803–809
doi: 10.1016/S0883-5403(99)90029-3
Pollak EW, Chavis P, Wolfman EF (1976) The effect of postural changes upon the ankle arterial perfusion pressure. Vasc Surg 10(4):219–222
doi: 10.1177/153857447601000404
Poulson W, Kamenskiy A, Seas A, Deegan P, Lomneth C, MacTaggart J (2018) Limb flexion-induced axial compression and bending in human femoropopliteal artery segments. J Vasc Surg 67(2):607–613. https://doi.org/10.1016/j.jvs.2017.01.071
doi: 10.1016/j.jvs.2017.01.071
pubmed: 28526560
Psathakis DN (1991) A new syndrome: the pseudo-entrapment of the popliteal artery and tibial nerve. Int Angiol 10(4):250–256
pubmed: 1797936
Raghavendra GK (2012) Does squatting worsen lower limb ischemia in patients with peripheral arterial disease? Indian J Surg 74(4):298–300. https://doi.org/10.1007/s12262-011-0364-9
doi: 10.1007/s12262-011-0364-9
pubmed: 23904717
Rosset E, Hartung O, Brunet C, Roche PH, Magnan PE, Mathieu JP, Branchereau A, Farisse J (1995) Popliteal artery entrapment syndrome. Anatomic and embryologic bases, diagnostic and therapeutic considerations following a series of 15 cases with a review of the literature. Surg Radiol Anat 17(2):161–169
doi: 10.1007/BF01627578
Rush B (1805) Medical inquiries and observations, vol 1. J. Conrad & Co, Philadelphia
Schep G, Bender MH, Schmikli SL, Wijn PF (2001a) Color Doppler used to detect kinking and intravascular lesions in the iliac arteries in endurance athletes with claudication. Eur J Ultrasound 14(2–3):129–140
doi: 10.1016/S0929-8266(01)00154-9
Schep G, Kaandorp DW, Bender MH, Weerdenburg H, van Engeland S, Wijn PF (2001b) Magnetic resonance angiography used to detect kinking in the iliac arteries in endurance athletes with claudication. Physiol Meas 22(3):475–487
doi: 10.1088/0967-3334/22/3/306
Schonauer C, Bocchetti A, Barbagallo G, Albanese V, Moraci A (2004) Positioning on surgical table. Eur Spine J 13(Suppl 1):S50-55. https://doi.org/10.1007/s00586-004-0728-y
doi: 10.1007/s00586-004-0728-y
pubmed: 15221573
pmcid: 3592178
Shahi N, Arosemena M, Kwon J, Abai B, Salvatore D, DiMuzio P (2019) Functional popliteal artery entrapment syndrome: a review of diagnosis and management. Ann Vasc Surg. https://doi.org/10.1016/j.avsg.2018.12.105
doi: 10.1016/j.avsg.2018.12.105
pubmed: 31028851
Sladojevic M, Dragas M, Koncar I, Radmili O, Markovic M, Davidovic L (2017) Transient acute leg ischemia in a professional athlete caused by isolated popliteal artery dissection mimicking popliteal entrapment syndrome. Ann Vasc Surg 43:316. https://doi.org/10.1016/j.avsg.2017.04.015
doi: 10.1016/j.avsg.2017.04.015
pubmed: 28479431
Smedby O, Hogman N, Nilsson S, Erikson U, Olsson AG, Walldius G (1993) Two-dimensional tortuosity of the superficial femoral artery in early atherosclerosis. J Vasc Res 30(4):181–191. https://doi.org/10.1159/000158993
doi: 10.1159/000158993
pubmed: 8357949
Stornelli N, Wydra FB, Mitchell JJ, Stahel PF, Fabbri S (2016) The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure. Patient Saf Surg 10:18. https://doi.org/10.1186/s13037-016-0106-9
doi: 10.1186/s13037-016-0106-9
pubmed: 27462369
pmcid: 4960854
Touliopolous S, Hershman EB (1999) Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med 27(3):193–204
doi: 10.2165/00007256-199927030-00005
Turnipseed WD, Pozniak M (1992) Popliteal entrapment as a result of neurovascular compression by the soleus and plantaris muscles. J Vasc Surg 15(2):285–293 (discussion 284–293)
doi: 10.1016/0741-5214(92)90250-C
Wensing PJ, Scholten FG, Buijs PC, Hartkamp MJ, Mali WP, Hillen B (1995) Arterial tortuosity in the femoropopliteal region during knee flexion: a magnetic resonance angiographic study. J Anat 187(Pt 1):133–139
pubmed: 7591974
pmcid: 1167356
Wesslen C, Wahlgren CM (2018) Contemporary management and outcome after lower extremity fasciotomy in non-trauma-related vascular surgery. Vasc Endovascular Surg 52(7):493–497. https://doi.org/10.1177/1538574418773503
doi: 10.1177/1538574418773503
pubmed: 29716475
Williamson S, Sanni AA, McCully KK (2019) The influence of muscle length on gastrocnemius and vastus lateralis muscle oxygen saturation and endurance. J Electromyogr Kinesiol 49:102358. https://doi.org/10.1016/j.jelekin.2019.102358
doi: 10.1016/j.jelekin.2019.102358
pubmed: 31563842
Yang C-C, Yang G-Y, Ger J, Tsai W-J, Deng J-F (1995) Severe rhabdomyolysis mimicking transverse myelitis in a heroin addict. J Toxicol Clin Toxicol 33(6):591–595. https://doi.org/10.3109/15563659509010614
doi: 10.3109/15563659509010614
pubmed: 8523478
Zhang S (2018) Why Can't Everyone Do the ‘Asian Squat’? All the way down! Not on your toes! Atlantic. https://www.theatlantic.com/health/archive/2018/03/can-you-do-the-asian-squat/555716/