Deep venous thrombosis and pulmonary embolism after ACL reconstruction: What can we do to prevent it?

Abstract

Deep venous thrombosis (DVT) and its most fatal complication, pulmonary embolism (PE), are manifestations of a single disease entity, that is, venous thromboembolism (VTE). VTE is a common and clinically relevant complication of major orthopedic surgery. Indeed, it is associated with a signi fi cant morbidity and mortality. With the advent of arthroscopic surgery, the incisions have become smaller and the rehabilitation faster, but in spite of this, there are reports of VTE following arthroscopic surgery. Most of the research is related to arthroscopic surgery alone. We have reviewed the literature and have found the DVT complication rate to be between 0.15 and 18 % in lower limb arthroscopic standard surgery (see Sect. 33.2). Arthroscopically assisted surgeries, like anterior cruciate ligament (ACL) reconstruction, are more aggressive than standard arthroscopy, take a longer time, and therefore should potentially be more predisposed to DVT. However, Jaureguito et al. [20] reported that patients undergoing arthroscopically assisted surgery had only a slightly higher incidence of DVT as compared to routine arthroscopic surgery, but this difference was not statistically signi fi cant. These fi ndings, in agreement with those of Hoppener et al. [15] did not fi nd a higher DVT risk in ACL reconstruction or in other more complex arthroscopic procedures. Also, Hetsroni et al. [13], after reviewing more 400,000 outpatient arthroscopies, found no increase in the PE risk when the arthroscopic procedure involved an ACL reconstruction or a meniscal repair, surgeries that theoretically would have a higher risk of VTE.