Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study

Nagashima, Masaki; Otani, Toshiro; Takeshima, Kaoru; Nakayama, Masanori; Origuchi, Nobuto; Ishii, Ken

doi:10.1136/jisakos-2019-000390

Cited by 10 publications

(17 citation statements)

References 17 publications

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“…Older age, 1 , 6 , 9 , 12 , 18 , 20 , 22 , 24 hypertension requiring medication, 1 and additional surgery (such as other ligament reconstructions and high tibial osteotomy) 1 , 4 , 22 have been reported as risk factors for DVT after ACLR. These factors cannot be controlled by the surgeon to reduce the risk.…”

Section: Discussionmentioning

confidence: 99%

“…The authors reported that 9 of 55 patients (16.4%) had DVT, and 4 of those (at least 7.3%) had PE. 18 Although all the cases were asymptomatic, the incidence of PE was revealed to be unexpectedly high. To the best of the authors’ knowledge, routine screening for DVT has not been shown to reduce the rate of fatal PE.…”

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confidence: 94%

“…Although the incidence of DVT after ACLR has been reported to be as low as 0.30% to 0.50% in large database studies, 1 , 6 , 9 , 12 it has been reported to range between 6.6% and 41.2% when examined by contract venography, ultrasonography, and magnetic resonance venography. 4 , 15 , 18 , 20 , 22 , 24 Thus, large databases may underestimate this incidence. The incidence of PE after ACLR has been reported to range from 0.05% to 0.21% in large database studies, 1 , 6 , 9 , 12 but there are few reports of PE examined by contrast-enhanced computed tomography (CECT).…”

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confidence: 99%

“…In a previous study, 18 VTEs were investigated using ultrasonography and CECT after ACLR with the use of a tourniquet. In that study, patients diagnosed with DVT underwent CECT to detect PE.…”

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confidence: 99%

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Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Nagashima

Takeshima

Origuchi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. Purpose: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. Results: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). Conclusion: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

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Section: Discussionmentioning

confidence: 99%

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confidence: 94%

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confidence: 99%

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confidence: 99%

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Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Nagashima

Takeshima

Origuchi

et al. 2021

Orthopaedic Journal of Sports Medicine

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“… 14 QTR is more common in elderly patients, and advanced age is a risk factor for DVT. 15 Since serious venous thrombosis has been reported after the surgical treatment of QTR, 9 adequate DVT prevention, including early rehabilitation, should be considered. Traditionally, QTR was typically treated by reattaching the ruptured tendons by end-to-end suturing of the torn tendon.…”

Section: Discussionmentioning

confidence: 99%

Suture Anchor Repair With Fully Threaded Knotless Anchors for Quadriceps Tendon Rupture Resulted in Favorable Outcomes After 2 Years

Sasaki

Nagashima

Otani

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To investigate clinical outcomes over 2 years in cases of quadriceps tendon rupture (QTR) that were surgically treated using fully threaded knotless anchors. Methods A total of four knees in four male patients with QTR repaired with fully threaded knotless anchors at our hospital from November 2017 to January 2019 were enrolled. Mean patient age at surgery was 65.3 years (range: 61-70 years). Intraoperatively, stability of the sutured site was confirmed by knee flexion to 90°. Full weight walking with the orthosis in extension was commenced on the seventh postoperative day. Surgical findings, pathologies of the ruptured quadriceps tendons, and postoperative clinical outcomes were evaluated in all patients. Results The QTR was complete in three cases and partial in one. Average surgical duration was 58.5 (range: 49–74) minutes. Pathological evaluation revealed hyaline degeneration with granulation of the quadriceps tendon in two cases. No complications, such as infection and rerupture, occurred. Magnetic resonance imaging performed 1 year postoperatively confirmed complete healing of the repaired tendon. The mean follow-up period was 35.5 months (range: 24–46 months). None of the patients had extension lag of the knee, and mean Lysholm score and range of flexion were 95.3 (range: 85–100) and 141.3° (range: 140–145°), respectively, at the final follow-up. Conclusions Clinical outcomes were favorable in all cases, including two cases with pathological degenerative changes. Suture anchor repair with fully threaded knotless anchors can be considered a minimally invasive and effective method for QTR, with sufficient strength to allow early rehabilitation.

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Incidence of and risk factors for deep vein thrombosis in patients undergoing osteotomies around the knee: comparative analysis of different osteotomy types

Onishi

Iseki

Kanto

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To examine the incidence of and risk factors for deep vein thrombosis (DVT) among diferent types of osteotomies around the knee. It was hypothesized that DVT would be detected at a substantial rate after the osteotomy, and there would be diferences in the incidences among the diferent osteotomy procedures. Methods Consecutive patients who underwent knee osteotomies for varus osteoarthritis and met the inclusion criteria were included in the study. Ultrasonographic evaluation was performed to detect DVT on bilateral whole leg at 1 month before and 7 days after surgery. Statistical comparison of the demographic and clinical parameters between the patients with and without DVT as well as multivariate analysis using logistic regression was conducted to identify risk factors related to the incidence of postoperative DVT. ResultsThe study subjects comprised 159 knees in 135 patients with medial opening wedge high tibial osteotomy (MOW-HTO), 93 knees in 78 patients with lateral closed wedge high tibial osteotomy (LCW-HTO), and 74 knees in 54 patients with double level osteotomy (DLO). In the postoperative evaluation, DVT was detected in 19 of 159 knees (11.9%) in MOW-HTO, 21 of 93 knees (22.6%) in LCW-HTO, and 5 of 74 knees (6.8%) in DLO. The incidence of DVT was signiicantly higher after LCW-HTO than after MOW-HTO and DLO (p < 0.01). DVT at a level above the knee was noted in one case after MOW-HTO, while DVT in the remaining cases developed at a level below the knee. No cases of symptomatic pulmonary embolism were encountered during the study period. Among the potential risk factors assessed for correlation with the incidence of DVT, LCW-HTO was identiied as a signiicant risk factor (odds ratio: 2.54; 95% CI 1.334-4.836; p < 0.01). Conclusions This study demonstrated that DVT occurred at a substantial rate (overall incidence of 13.8%) after osteotomy around the knee even with the use of prophylactic anticoagulant. Among the diferent osteotomy types, the DVT rate was signiicantly higher after LCW-HTO than after MOW-HTO and DLO. Level of evidence Prospectively designed observational cohort study, Level III.

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Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study

Cited by 10 publications

References 17 publications

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Suture Anchor Repair With Fully Threaded Knotless Anchors for Quadriceps Tendon Rupture Resulted in Favorable Outcomes After 2 Years

Incidence of and risk factors for deep vein thrombosis in patients undergoing osteotomies around the knee: comparative analysis of different osteotomy types

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