Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

Abstract

AIMTo summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction.METHODSA systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined.RESULTSFourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism.CONCLUSIONAfter ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.

Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

“…VTE is a significant perioperative complication occurring after many orthopaedic procedures, especially surgeries involving the knee. 1 , 2 , 5 , 8 , 13 There is currently no standard recommendation for chemical prophylaxis after ACL reconstruction. This study’s findings show that 50% of sports medicine fellowship–trained orthopaedic surgeons in the United States routinely use chemical prophylaxis for perioperative thrombotic risk after ACL reconstruction.…”

“…Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. 1 , 5 , 8 , 13 ACL reconstruction carries a risk of developing symptomatic and asymptomatic DVT. A previous systematic review reported the risks of developing asymptomatic DVT, symptomatic DVT, and pulmonary embolism (PE) after ACL reconstruction were 8.4%, 2.3%, and 0.2%, respectively.…”

“…A previous systematic review reported the risks of developing asymptomatic DVT, symptomatic DVT, and pulmonary embolism (PE) after ACL reconstruction were 8.4%, 2.3%, and 0.2%, respectively. 5 Janssen et al 8 found the rate of developing symptomatic DVT after ACL reconstruction to be 2.1%; that for PE was only 0.1%. Although this is a relatively low incidence, the morbidity can be significant with VTE.…”

Delayed vascular complications after orthopaedic surgery: A report of two cases and review of the literature

“…Pseudoaneurysms differ from true aneurysms in that they do not contain all the layers of an artery. 1 A pseudoaneurysm evolves into a haematoma if blood passes through the adventitia and collects in the surrounding tissue external to the three vessel layers. Damage occurs due to partial division and erosion of the pulsating arterial wall, often by the projection of metallic screws or hardware.…”

Arteriovenous Fistula after Anatomic All-Inside Anterior Cruciate Ligament Reconstruction

“…Vascular complications after ACL reconstructions are rare but can cause serious morbidity and potential mortality [ 4 ]. Vascular complications may occur after various methods of reconstruction and fixation [ 5 ]. Since 2013, we have switched to the all-inside ACL reconstruction technique (Arthrex, München).…”