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Clinical Orthopaedics and Related Research®

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01.09.2014 | Symposium: Management of the Dislocated Knee

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

verfasst von: Trevor R. Born, MD, William M. Engasser, MD, Alexander H. King, Aaron J. Krych, MD, Diane L. Dahm, MD, Bruce A. Levy, MD, Michael J. Stuart, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 9/2014

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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.

Adala R, Anand A, Kodikal G. Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction. Indian J Orthop. 2011;45:450–453.PubMedCentralPubMedCrossRef

Berry DJ. Surveillance for venous thromboembolic disease after total knee arthroplasty. Clin Orthop Relat Res. 2001;392:257–266.PubMedCrossRef

Bushnell BD, Anz AW, Bert JM. Venous thromboembolism in lower extremity arthroscopy. Arthroscopy. 2008;24:604–611.PubMedCrossRef

Camporese G, Bernardi E, Prandoni P, Noventa F, Verlato F, Simioni P, Ntita K, Salmistraro G, Frangos C, Rossi F, Cordova R, Franz F, Zucchetta P, Kontothanassis D, Andreozzi GM. Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med. 2008;149:73–82.PubMedCrossRef

Dahl OE, Gudmundsen TE, Haukeland L. Late occurring clinical deep vein thrombosis in joint-operated patients. Acta Orthop Scand. 2000;71:47–50.PubMedCrossRef

Delis KT, Hunt N, Strachan RK, Nicolaides AN. Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy. Thromb Haemost. 2001;86:817–821.PubMed

Demers C, Marcoux S, Ginsberg JS, Laroche F, Cloutier R, Poulin J. Incidence of venographically proved deep vein thrombosis after knee arthroscopy. Arch Intern Med. 1998;158:47–50.PubMedCrossRef

Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc. 2011;19:162–166.PubMedCrossRef

Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc. 2009;17:1013–1026.PubMedCrossRef

10.

Fahmy NR, Patel DG. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am. 1981;63:461–465.PubMed

11.

Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e278S–325S.PubMedCentralPubMedCrossRef

12.

Fanelli GC. Posterior cruciate ligament rehabilitation: how slow should we go? Arthroscopy. 2008;24:234–235.PubMedCrossRef

13.

Fanelli GC, Stannard JP, Stuart MJ, MacDonald PB, Marx RG, Whelan DB, Boyd JL, Levy BA. Management of complex knee ligament injuries. J Bone Joint Surg Am. 2010;92:2235–2246.PubMed

14.

Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ, Levy BA. Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2010;18:1583–1586.PubMedCrossRef

15.

Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86:262–273.PubMed

16.

Hetsroni I, Lyman S, Do H, Mann G, Marx RG. Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418,323 arthroscopies. J Bone Joint Surg Br. 2011;93:47–51.PubMedCrossRef

17.

Hoppener MR, Ettema HB, Henny CP, Verheyen CC, Buller HB. Symptomatic deep vein thrombosis and immobilization after day-care arthroscopy of the knee. J Thromb Haemost. 2005;3:185–187.PubMedCrossRef

18.

Janssen RP, Sala HA. Fatal pulmonary embolism after anterior cruciate ligament reconstruction. Am J Sports Med. 2007;35:1000–1002.PubMedCrossRef

19.

Jones RE, Smith EC, Bone GE. Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet. 1979;149:554–558.PubMed

20.

Kapoor A, Chew P, Silliman RA, Hylek EM, Katz JN, Cabral H, Berlowitz D. Venous thromboembolism after joint replacement in older male veterans with comorbidity. J Am Geriatr Soc. 2013;61:590–601.PubMedCentralPubMedCrossRef

21.

Kieser C. A review of the complications of arthroscopic knee surgery. Arthroscopy. 1992;8:79–83.PubMedCrossRef

22.

Lapidus LJ, Ponzer S, Pettersson H, de Bri E. Symptomatic venous thromboembolism and mortality in orthopaedic surgery–an observational study of 45 968 consecutive procedures. BMC Musculoskelet Disord. 2013;14:177.PubMedCentralPubMedCrossRef

23.

Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009;25:430–438.PubMedCrossRef

24.

Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17:197–206.PubMed

25.

Levy BA, Krych AJ, Shah JP, Morgan JA, Stuart MJ. Staged protocol for initial management of the dislocated knee. Knee Surg Sports Traumatol Arthrosc. 2010;18:1630–1637.PubMedCrossRef

26.

Levy BA, Stuart MJ. Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic. J Knee Surg. 2012;25:295–305.PubMedCrossRef

27.

Levy BA, Zlowodzki MP, Graves M, Cole PA. Screening for extermity arterial injury with the arterial pressure index. Am J Emerg Med. 2005;23:689–695.PubMedCrossRef

28.

Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S, Vecsei V. Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy. 2007;23:696–702.PubMedCrossRef

29.

Mauck KF, Froehling DA, Daniels PR, Dahm DL, Ashrani AA, Crusan DJ, Petterson TM, Bailey KR, Heit JA. Incidence of venous thromboembolism after elective knee arthroscopic surgery: a historical cohort study. J Thromb Haemost. 2013;11:1279–1286.PubMedCrossRef

30.

Meyers MH, Moore TM, Harvey JP Jr. Traumatic dislocation of the knee joint. J Bone Joint Surg Am. 1975;57:430–433.PubMed

31.

Michot M, Conen D, Holtz D, Erni D, Zumstein MD, Ruflin GB, Renner N. Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxis with low-molecular weight heparin. Arthroscopy. 2002;18:257–263.PubMedCrossRef

32.

Montebugnoli M, Bugamelli S, Calo P, Zangheri E, Ferrari P. Prophylaxis of venous thromboembolism in minor orthopedic surgery with parnaparin. Clin Appl Thromb Hemost. 2007;13:249–258.PubMedCrossRef

33.

Mook WR, Ligh CA, Moorman CT 3rd, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg. 2013;21:343–354.PubMedCrossRef

34.

Navarro-Sanz A, Fernandez-Ortega JF. Fatal pulmonary embolism after knee arthroscopy. Am J Sports Med. 2004;32:525–528.PubMedCrossRef

35.

O’Reilly RF, Burgess IA, Zicat B. The prevalence of venous thromboembolism after hip and knee replacement surgery. Med J Aust. 2005;182:154–159.PubMed

36.

Peskun CJ, Levy BA, Fanelli GC, Stannard JP, Stuart MJ, MacDonald PB, Marx RG, Boyd JL, Whelan DB. Diagnosis and management of knee dislocations. Phys Sportsmed. 2010;38:101–111.PubMedCrossRef

37.

Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg. 2008;21:261–268.PubMedCrossRef

38.

Price AJ. Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am. 1982;64:1260.PubMed

39.

Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004;12:334–346.PubMed

40.

Rozencwaig R, Shilt JS, Ochsner JL Jr. Fatal pulmonary embolus after knee arthroscopy. Arthroscopy. 1996;12:240–241.PubMedCrossRef

41.

Salvo JP, Troxell CR, Duggan DP. Incidence of venous thromboembolic disease following hip arthroscopy. Orthopedics. 2010;33:664.PubMed

42.

Schenk R. Classification of knee dislocations. Oper Tech Sports Med. 2003;11:193–198.CrossRef

43.

Sems SA, Levy BA, Dajani K, Herrera DA, Templeman DC. Incidence of deep venous thrombosis after temporary joint spanning external fixation for complex lower extremity injuries. J Trauma. 2009;66:1164–1166.PubMedCrossRef

44.

Sherman OH, Fox JM, Snyder SJ, Del Pizzo W, Friedman MJ, Ferkel RD, Lawley MJ. Arthroscopy–’no-problem surgery.’ An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am. 1986;68:256–265.PubMed

45.

Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy. 1988;4:215–221.PubMedCrossRef

46.

Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee. 2010;17:141–147.

47.

Stringer MD, Steadman CA, Hedges AR, Thomas EM, Morley TR, Kakkar VV. Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients. J Bone Joint Surg Br. 1989;71:492–497.PubMed

48.

Struijk-Mulder MC, Ettema HB, Verheyen CC, Buller HR. Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study of 100 patients. Arthroscopy. 2013;29:1211–1216.PubMedCrossRef

49.

Tay AK, MacDonald PB. Complications associated with treatment of multiple ligament injured (dislocated) knee. Sports Med Arthrosc. 2011;19:153–161.PubMedCrossRef

50.

Wascher DC, Becker JR, Dexter JG, Blevins FT. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med. 1999;27:189–196.PubMed

51.

Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implication for treatment. J Orthop Trauma. 1997;11:525–529.PubMedCrossRef

52.

Welling RE, Kakkasseril J, Cranley JJ. Complete dislocations of the knee with popliteal vascular injury. J Trauma. 1981;21:450–453.PubMed

53.

Williams JS Jr, Hulstyn MJ, Fadale PD, Lindy PB, Ehrlich MG, Cronan J, Dorfman G. Incidence of deep vein thrombosis after arthroscopic knee surgery: a prospective study. Arthroscopy. 1995;11:701–705.PubMedCrossRef

54.

Wirth T, Schneider B, Misselwitz F, Lomb M, Tuylu H, Egbring R, Griss P. Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized controlled trial. Arthroscopy. 2001;17:393–399.PubMedCrossRef

55.

Ye S, Dongyang C, Zhihong X, Dongquan S, Jin D, Jianghui Q, Jizhen Q, Pu Y, Huacheng H, Wei S, Qing J. The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction. Arthroscopy. 2013;29:742–747.PubMedCrossRef

Titel: Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis
verfasst von: Trevor R. Born, MD
William M. Engasser, MD
Alexander H. King
Aaron J. Krych, MD
Diane L. Dahm, MD
Bruce A. Levy, MD
Michael J. Stuart, MD
Publikationsdatum: 01.09.2014
Verlag: Springer US
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 9/2014
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3576-z

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