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

Table 5 Incidence venous thromboembolism, risk factors and thromboprophylaxis recommendations

Ref.	Study design	Incidence DVT (symptomatic if specified)	Incidence PE (symptomatic if specified)	Detection method VTE	Risk factors DVT	Thromboprophylaxis recommendations
Marlovits et al[20]	RCT	2 = 2.8% with extended prophylaxis; 28 = 41.2% without extended prophylaxis	0%	MRI venography	Comparable between groups	Age > 30, prolonged immobilisation and complex procedures
Mohtadi et al[21]	RCT	1 (0.3%) symptomatic	1 (0.3%) symptomatic	Clinical, additional exam in suspected cases	None	-
Adala et al[6]	PC	2 = 1.78% (1 pt symptomatic)	0%	Ultrasound preop and day 2-3	None	None if absent high risk factors DVT or age < 45 yr
Cullison et al[10]	PC	1 = 1.5%	0%	Ultrasound preop, day 3 and 4 wk	None	None in male patients < 40 yr and absence of risk factors
Hirota et al[25]	PC	0%	Peak emboli 50s after tourniquet release	Transoesophageal echocardiography	?	-
Hirota et al[22]	PC	0%	0%	Transoesophageal echocardiography	?	-
Lind et al[23]	PC	?	?	?	?	-
Maletis et al[11]	PC	26 = 0.2% in primary ACLR	15 = < 0.1% in primary ACLR	Various methods	?	?
		2 = 0.2% in revision ACLR	0% in revision ACLR	Idem	?	?
Struijk-Mulder et al[5]	PC	9 = 9.0% (symptomatic 4 = 4.0%)	1 = 1%	Bilateral ultrasound	Age, contraceptive use	Further research for DVT prophylaxis, especially when risk factors are present
Williams et al[24]	PC	0%	0%	Bilateral ultrasound preop and 7-14 d postop	In 3 patients, non-specified	Future studies needed
Born et al[26]	RC	3 = 2.0% sympromatic	?	Clinical, ultrasound in suspected cases	Multiligamentous injury, age, history DVT	In multiligament reconstruction. cf guidlines ACCP "major orthopaedic surgery"
Dong et al[8]	RC	17 = 8.5% (44.1% nonsymptomatic of all DVT cases = 12.1% of all patients)	?	Color doppler ultrasound < 24 h after admission and 3 and 7 d postsurgery	Multiligament reconstruction, tourniquet time > 2 h, age	In case of PCL reconstruction and tourniquet time > 2 h
Ettema et al[27]	RC	?	?	?	?	None
Gaskill et al[2]	RC	55 symptomatic	35	Clinical, additional exam in suspected cases	Age ≥ 35, smoking, cocomitant HTO/PCL surgery	Further research for VTE prophylaxis
Hetsroni et al[30]	RC	?	117 = 0.0003% all symptomatic	Clinical, additional exam in suspected cases	Female gender, age, surgical time, previous cancer	Further research for thromboprophylaxis in high risk patients
Jameson et al[28]	RC	42 = 0.3% all symptomatic	25 = 0.8% all symptomatic	Clinical, additional exam in suspected cases	Age > 40	No advise due to lack of evidence
Jaureguito et al[7]	RC	Retrospectively clinically 0.24% Prospectively 7 (2.9%, 5 asymptomatic = 2.1%)	0%	Duplex ultrasonography pre-operatively and 5 and 10 d postsurgery	None	-
Sun et al[29]	RC	total 36 = 15.6% (4 prox DVT = 2.4%. Distal DVT 32 = 13.9%)	0%	Venography day 3 postsurgery	Age, multiligament surgery	None
Ye et al[4]	RC	24 = 14.0% (4 pts prox. DVT)	0%	Chest X-ray and venography day 3 post ACLR	Female gender, age > 35 yr	In female patients and age > 35 yr
Ackerman et al[55]	CR	1 = 100%	0%	Clinical, ultrasound, CT and venography	May-Thurner Syndrome	In case of high risk patient
Chien et al[50]	CR	?	1 = 100%	Clinical, CT scan	BMI, ACL surgery	Further investigation for thromboprophylaxis after knee arthroscopy needed
Janssen et al[47]	CR	1 = 100%	1 = 100%	Clinical, transoesophageal echocardiography	Misdiagnosis DVT, Protein S deficiency? ACL surgery, contraceptive use	Further investigation for thromboprophylaxis after knee arthroscopy needed
Kang et al[51]	CR	1 = 100%	0%	Clinical, ultrasound	Primary thrombocytopenia, Factor VIII, Proteine C and S	None
Liu et al[52]	CR	1 = 100%	1 = 100%	Clinical, cardiac sonography	BMI	Patients with increased risk and prolonged tourniquet time
Theron et al[53]	CR	?	1 = 100%	Clinical, CT	Contraceptive use	None

ACLR: ACL reconstruction; BPTB: Bone-patellar tendon-bone; TKA: Total knee arthroplasty; LMWH: Low molecular weight heparin; HTO: High tibial osteotomy; VTE: Venous thromboembolism; PCL: Posterior cruciate ligament; prim: Primary; RCT: Randomized controlled trial; PC: Prospective cohort study; RS: Retrospective study; CR: Case report; CT-scan: Computerized tomography-scan; BMI: Body mass index; DVT: Deep venous thrombosis; ACL: Anterior cruciate ligament; rec.: Reconstruction; pts: Patients; prox.: Proximal.