Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Abstract

Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients

“…3,5 In our study, patients who received chemoprophylaxis had risk factors known to be associated with a higher incidence of VTE; they were older, had a higher BMI, suffered from more comorbidities, were more likely to have a previous history of VTE, and had a longer operation time. 1,4,6,26,27,31 We believe that there would have been a great increase in the number of VTEs had the patients in our chemoprophylaxis group not been given anticoagulation. Moreover, we found no significant difference in the rates of PE in the chemoprophylaxis and nonchemoprophylaxis groups, despite a difference in the rate of DVT, which suggests that anticoagulant therapy might lower the rate of PE in patients who are at a higher risk for it.…”

“…Our analysis differs from those in the existing literature in that we included a larger, broader group of spine surgery patients. Previous studies of patients undergoing spine surgery have examined the incidence of postoperative VTE, 1,4,25,28,30,33 the effectiveness of chemoprophylaxis for VTE prevention, 2,7,19,24 and complications from anticoagulant therapy. 9,12 However, these researchers limited their patient populations to specific spinal procedures, such as operative fixation after traumatic spine fracture, 23 degenerative spinal surgery, 33 decompression, and fusion procedures.…”

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

“…The PRISMA flow chart of the systematic review is presented in Figure 1 . A total of 47 studies were included: 2 randomized controlled trials (RCT)[ 20 , 21 ], 8 prospective cohort studies[ 5 , 6 , 10 , 11 , 22 - 25 ], 9 retrospective cohort studies[ 2 , 4 , 7 , 8 , 26 - 30 ] and 28 case reports[ 13 , 31 - 57 ].…”

Incidence of Deep Venous Thrombosis Associated With Proximal Hamstring Rupture

“…Nonweightbearing or limited weightbearing is seen in multiligament knee reconstruction, where a 2% rate of DVT has been found. 8 Hip arthroscopy is proximal in the lower extremity like hamstring ruptures, may have a similar patient population, and may involve restricted weightbearing; DVT rates have been shown at 0.1% to 0.79%. 18,29 These patients tend not to be immobilized, and the preceding injury is less traumatic.…”