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Abstract

Context:

Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented.

Objective:

To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction.

Data Sources:

Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized.

Study Selection:

All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded.

Study Design:

Systematic review.

Level of Evidence:

Level 4.

Data Extraction:

All study, subject, and surgical data were analyzed. Descriptive statistics were calculated.

Results:

Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone–patellar tendon–bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic.

Conclusion:

The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic.

Keywords

deep venous thrombosis pulmonary embolus prophylaxis anterior cruciate ligament reconstruction knee thromboembolic disease

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References

Adala

Anand

Kodikal

. Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction. Indian J Orthop. 2011;45:450-453.

Adam

McDuffie

Lachiewicz

Ortel

Williams

Jr . Comparative effectiveness of new oral anticoagulants and standard thromboprophylaxis in patients having total hip or knee replacement: a systematic review. Ann Intern Med. 2013;159:275-284.

Chahal

Lee

Heard

Bach

Jr . A retrospective review of anterior cruciate ligament reconstruction using patellar tendon: 25 years of experience. Orthop J Sports Med. 2013;1(3):2325967113501789.

Cowan

Lozano-Calderon

Ring

. Quality of prospective controlled randomized trials. Analysis of trials of treatment for lateral epicondylitis as an example. J Bone Joint Surg Am. 2007;89:1693-1699.

Cullison

Muldoon

Gorman

Goff

. The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction. Arthroscopy. 1996;12:657-659.

DeHaven

Lintner

. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med. 1986;14:218-224.

Dong

Wang

Men

Wang

Zheng

Gao

. Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction [published online November 2, 2014]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3216-x.

Erickson

Harris

Cole

. Performance and return to sport after anterior cruciate ligament reconstruction in National Hockey League players. Orthop J Sports Med. 2014;2:2325967114548831.

Frank

Jackson

. The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am. 1997;79:1556-1576.

10.

Griffin

Agel

Albohm

. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8:141-150.

11.

Hamidi

Ringerike

Hagen

Reikvam

Klemp

. New anticoagulants as thromboprophylaxis after total hip or knee replacement. Int J Technol Assess Health Care. 2013;29:234-243.

12.

Jacobs

Mont

Bozic

. American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am. 2012;94:746-747.

13.

Kwok

Harrison

Servant

. The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy. 2013;29:556-565.

14.

LaBella

Hennrikus

Hewett

; Council on Sports Medicine and Fitness, and Section on Orthopaedics. Anterior cruciate ligament injuries: diagnosis, treatment, and prevention. Pediatrics. 2014;133:e1437-e1450.

15.

Lazo-Langner

Fleet

McArthur

Garg

. Rivaroxaban vs. low molecular weight heparin for the prevention of venous thromboembolism after hip or knee arthroplasty: a cohort study. J Thromb Haemost. 2014;12:1626-1635.

16.

Leroux

Wasserstein

Dwyer

. The epidemiology of revision anterior cruciate ligament reconstruction in Ontario, Canada. Am J Sports Med. 2014;42:2666-2672.

17.

Liberati

Altman

Tetzlaff

. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1-e34.

18.

Marengoni

Pasina

Concoreggi

. Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med. 2014;25:843-846.

19.

Marlovits

Striessnig

Schuster

. Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy. 2007;23:696-702.

20.

Marrale

Morrissey

Haddad

. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007;15:690-704.

21.

Michot

Conen

Holtz

. Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxis with low–molecular weight heparin. Arthroscopy. 2002;18:257-263.

22.

Munoa

Gonzalez

Diaz de Rada

Valenti

. Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy. Musculoskelet Surg. 2014;98:21-25.

23.

Raphael

Tischler

Huang

Rothman

Hozack

Parvizi

. Aspirin: an alternative for pulmonary embolism prophylaxis after arthroplasty? Clin Orthop Relat Res. 2014;472:482-488.

24.

Russell

Hotchkiss

Knight

Huo

. The efficacy and safety of rivaroxaban for venous thromboembolism prophylaxis after total hip and total knee arthroplasty. Thrombosis. 2013;2013:762310.

25.

Struijk-Mulder

Ettema

Verheyen

Büller

. Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study of 100 patients. Arthroscopy. 2013;29:1211-1216.

26.

The University of Oxford Centre for Evidence Based Medicine. The Oxford Levels of Evidence 2. Oxford: Oxford Centre for Evidence Based Medicine; 2012.

27.

The University of York Centre for Reviews and Dissemination. International prospective register of systematic reviews. 2014. http://www.crd.york.ac.uk/PROSPERO/. Accessed December 4, 2014.

28.

Wang

Anderson

Jr Ward

Bhattacharyya

. Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty. PLoS One. 2014;9:e91755.

29.

Williams

Jr Hulstyn

Fadale

. Incidence of deep vein thrombosis after arthroscopic knee surgery: a prospective study. Arthroscopy. 1995;11:701-705.

30.

Wirth

Schneider

Misselwitz

. Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized controlled trial. Arthroscopy. 2001;17:393-399.

31.

Dongyang

Zhihong

. The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction. Arthroscopy. 2013;29:742-747.

32.

Yen

Lin

Kuo

Wang

. Thromboprophylaxis after minimally invasive total knee arthroplasty: a comparison of rivaroxaban and enoxaparin. Biomed J. 2014;37:199-204.

33.

Tan

Chen

Huang

. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2014;134:1469-1476.

Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

Abstract

Context:

Objective:

Data Sources:

Study Selection:

Study Design:

Level of Evidence:

Data Extraction:

Results:

Conclusion:

Keywords

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References