Incidence and risk factors of deep venous thrombosis following arthroscopic posterior cruciate ligament reconstruction

Abstract

The objective of this study was to identify the incidence and associated risk factors for deep venous thrombosis (DVT) after arthroscopic posterior cruciate ligament (PCL) reconstruction.This study included 128 patients who underwent arthroscopic PCL reconstruction. Venography was performed on the operated leg 3 days postoperatively. The patients were divided into 2 groups based on whether they had DVT. A correlation analysis was performed to determine the factors associated with DVT.Of all the 128 patients, 28 patients (21.9%) developed DVT, with 4 (3.1%) in a proximal location. Significant differences were found in the mean age, time of application of tourniquet, mean VAS scores, mean d-dimer level, mean cholesterol level, and various surgical procedures in patients with DVT compared with those without DVT. DVT is difficult to diagnose solely based on clinical symptoms.The incidence of DVT was 21.9% in patients who underwent arthroscopic PCL reconstruction. The rate of asymptomatic clots in the calf region was rather high after PCL reconstruction, and the rate of proximal clots was 4%. Older age, longer durations of tourniquet application, higher VAS scores and D-dimer levels, and complex surgical procedures were all substantial risk factors for DVT after PCL reconstruction. The treatment of DVT with batroxobin and anticoagulants was effective and safe.

Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic Posterior Cruciate Ligament Reconstruction: A Retrospective Observational Study

“…D-dimer is widely used in clinical practice as an indicator to monitor DVT with a high sensitivity and specificity. 32 Although the D-dimer level is affected by inflammation, bleeding, and some other factors, 9 effective anticoagulation is still necessary for patients with high D-dimer levels after knee arthroscopic PCL reconstruction. Considering the fact that the hypercoagulable status of patients after surgery usually lasts no more than 48 hours which is the peak period of the formation of acute DVT in the lower limbs, 7 the blood D-dimer level was routinely measured on postoperative day 3 in this study and then the ultrasound of both legs was performed.…”

“…Subsequently, DVT is confirmed to be occurred in 21.90% of the patients after arthroscopic posterior cruciate ligament reconstruction with venography examination, among DVTs, 10.16% were asymptomatic and 11.72% were symptomatic. 9 Considering the objective factors such as the high-energy mechanism of posterior cruciate ligament (PCL) injury, relatively long operation time, and special anatomical structures of PCL, Dong et al stated that postoperative DVT incidence diagnosed by ultrasound following PCL reconstruction without thromboprophylaxis was 17.40% and a high proportion of asymptomatic thrombosis existed. 1 In a study of 30 patients with PCL rupture who underwent arthroscopic reconstruction, Hagino et al 10 evaluated DVT based on postoperative symptoms and found no symptomatic thrombosis.…”

Common risk factors of deep vein thrombosis after arthroscopic posterior cruciate ligament reconstruction: a 5-year retrospective study

“…D-dimer is widely used in clinical practice as an indicator to monitor DVT with a high sensitivity and speci city [22]. Although the D-dimer level is affected by in ammation, bleeding and some other factors [9], effective anticoagulation is still necessary for patients with high D-dimer levels after knee arthroscopic PCL reconstruction. Considering the fact that the hypercoagulable status of patients after surgery usually lasts no more than 48 hours which is the peak period of the formation of acute DVT in the lower limbs [7], the blood D-dimer level was routinely measured on postoperative day 3 in this study and then the ultrasound of both legs was performed.…”

“…However, recent studies have shown that the incidence of DVT after knee arthroscopy was 1.50% − 41.20% without anticoagulation during the perioperative period [6]. Noteworthily, the incidence of DVT after arthroscopic anterior cruciate ligament reconstruction can reach 8.00% − 41.20% [9]. Considering the objective factors such as the high-energy mechanism of posterior cruciate ligament (PCL) injury, relatively long operation time, and special anatomical structures of PCL, Dong et al stated that postoperative DVT incidence in patients undergoing arthroscopic PCL reconstruction without thromboprophylaxis was 17.40% [1].…”

“…Some epidemiological studies have shown that common risk factors such as age, gender, and body mass index (BMI) can partly affect the occurrence of DVT [10]. To our best knowledge, reearches on whether perioperative prophylaxis should be used in patients undergoing knee arthroscopic PCL surgery and how to do a targeted anticoagulant therapy in these patients have yielded con icting results [1,9]. Still, DVT prophylaxis may potentially lead to the risks of deep in ammation, bleeding events, and prolonged wound drainage [11].…”