Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2016; 7(9): 604-617
Published online Sep 18, 2016. doi: 10.5312/wjo.v7.i9.604
Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, 5600PD, Eindhoven, The Netherlands
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Orthopaedics and Trauma, Máxima Medical Center, 5500 Veldhoven, The Netherlands
Max Reijman, Department of Orthopaedic Surgery Erasmus MC, University Medical Center Rotterdam, 3100 Rotterdam, The Netherlands
Author contributions: Janssen RPA, Janssen DM, Reijman M and van Mourik JBA performed the systematic review; Reijman M performed the statistical analysis; Janssen RPA and Reijman M wrote the paper.
Conflict-of-interest statement: None of the authors have any conflict of interest in this research.
Data sharing statement: No data were created so no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rob Paulus Augustinus Janssen, MD, PhD, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, Postbus 90052, 5600PD, Eindhoven, The Netherlands. r.janssen@mmc.nl
Telephone: +31-40-8885936 Fax: +31-40-8885938
Received: February 17, 2016
Peer-review started: February 19, 2016
First decision: March 25, 2016
Revised: May 14, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: September 18, 2016
Processing time: 207 Days and 16.3 Hours
Abstract
AIM

To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction.

METHODS

A 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.

RESULTS

Fourty-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.

CONCLUSION

After 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.

Keywords: Anterior cruciate ligament reconstruction; Arterial complication; Pseudoaneurysm; Venous thromboembolism; Pulmonary embolism; Thromboprophylaxis

Core tip: Vascular complications after anterior cruciate ligament (ACL) reconstruction of the knee may present serious morbidity and even mortality. Although rare, it is necessary to understand the main risks and symptoms of these devastating lesions. This systematic review presents the current knowledge on arterial injuries, venous thromboembolism and thromboprophylaxis after ACL reconstruction.