Mary Cecilia Cain

All Publications

• Functional Popliteal Artery Entrapment Syndrome in Athletes: Insights from the Patient Perspective. Annals of vascular surgery Cain, M. C., Cabot, J. H., Akkineni, S. S., Yang, L., Shalita, C., Lee, J. T. 2026

  Abstract

  Functional popliteal artery entrapment syndrome (fPAES) is a rare cause of exertional leg pain in athletes that is frequently underdiagnosed. This study aimed to characterize the patient perspective, including symptom presentation, recovery, and return to sport following surgical treatment. A mixed-methods study was conducted in patients undergoing surgery for fPAES. Functional outcomes were assessed using the Tegner Activity Scale (0 = no activity, 10 = full activity), and structured interviews were analyzed to evaluate symptom burden, diagnostic delay, and psychosocial impact. Thirty-six patients (64 limbs) were included with a mean follow-up of 8.3 years. The average time from symptom onset to diagnosis was 57.5 months. The most commonly reported symptoms were calf pain (89%), neurologic symptoms (42%), rest pain (33%), cold sensation (31%), and swelling (19%). Neurologic symptoms were associated with a higher likelihood of full recovery, whereas pain at rest was associated with incomplete improvement in most cases. Functional improvement at 1 year was 80%. Higher preoperative activity levels were associated with lower odds of improvement (p = 0.0017). Younger patients (<20 years) more frequently reported incomplete recovery compared with older groups; however, all returned to sport, and adjunctive botulinum toxin therapy appeared beneficial. Surgical treatment provides durable symptom relief and high rates of return to sport, although delayed diagnosis remains common and younger athletes may be at increased risk of incomplete recovery.

  View details for DOI 10.1016/j.avsg.2026.09.017

  View details for PubMedID 42800667

• Prevailing Language Discordance is associated with Worse Post-operative Outcomes in Adult Cardiac Surgical Patients Cain, M., McMullen, H., Pines, K., Shields, L., Xie, J., Sun, L., Martin, B. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1161/circ.152.suppl_3.4372241

  View details for Web of Science ID 001613929800047

• Midterm outcomes from a 20-year experience treating functional popliteal artery entrapment syndrome in athletes. Journal of vascular surgery Cabot, J. H., Yang, L., Shalita, C., Fereydooni, A., Cain, M., Lee, J. T. 2025

  Abstract

  Functional popliteal artery entrapment syndrome (FPAES) is a rare condition affecting young, active individuals presenting with claudication, swelling, or paresthesias, and often impairing athletic performance. Our standardized approach to this disease process involves testing with arterial duplex/digit plethysmography and provocative CT-angiography followed by surgical debulking consisting of popliteal artery release and resection of the anterolateral quadrant of the medial head of the gastrocnemius muscle and four-compartment fasciotomy. We sought to determine risk factors for clinical success versus recurrent symptoms in athletes undergoing surgery for FPAES.Retrospective review was conducted for consecutive athletes undergoing surgery for FPAES at a single institution. Demographics, preoperative symptoms, imaging findings, operative details, and postoperative outcomes were recorded, with primary outcome being return to prior level of sport, and secondary outcomes postoperative complications and long-term symptom recurrence.From 2005-2025 we operated on 125 limbs of 73 athletes. Most athletes competed at the collegiate level (38.4%), were female (64.5%), and had bilateral symptoms (84.2%). The most common sports represented were running (43.8%), soccer (26.0%), basketball (5.5%), lacrosse (5.5%), and water sports (5.5%). Surgical debulking was guided by CTA compression of the gastrocnemius muscle and mean muscle volume resected was 6.86cm3. Concurrent fasciotomies were performed in 90 of 125 cases (72.0%). Symptom improvement at latest follow-up (mean 14 months) was reported in 86.5% of limbs, with 82.4% able to return to prior competitive level of sport. On multivariable regression, concurrent fasciotomy (OR 3.03, P=0.038) and male gender (OR 5.16 P=0.038) were associated with a higher likelihood of return to sport. Delayed symptom recurrence was observed in 11.2% of limbs, at a median time to recurrence of 369 days IQR (210 -747). In a Cox proportional hazards model, males had a significantly lower risk of long-term recurrence compared to females (HR = 0.08, P=0.016).FPAES is a rare yet impactful condition that limits athletes' ability to perform at high levels. This study represents the largest reported cohort to date, providing a 20-year experience of a standardized radiographic workup, symptom inventory, and definitive surgical treatment. Partial debulking of the medial head of the gastrocnemius after popliteal artery release is a safe and effective intervention, and when combined with concurrent fasciotomy appears to further improve outcomes. Male athletes appear to have improved outcomes with higher rates of return to sport and lower rates of symptom recurrence.

  View details for DOI 10.1016/j.jvs.2025.05.002

  View details for PubMedID 40480615

• #REDS (Relative Energy Deficiency in Sport): time for a revolution in sports culture and systems to improve athlete health and performance. British journal of sports medicine Ackerman, K. E., Stellingwerff, T., Elliott-Sale, K. J., Baltzell, A., Cain, M., Goucher, K., Fleshman, L., Mountjoy, M. L. 2020; 54 (7): 369-370

  View details for DOI 10.1136/bjsports-2019-101926

  View details for PubMedID 31924625