Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Abstract

Context: Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented.

Objective: To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction.

Data sources: Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized.

Study selection: All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: All study, subject, and surgical data were analyzed. Descriptive statistics were calculated.

Results: Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone-patellar tendon-bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic.

Conclusion: The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic.

Keywords: anterior cruciate ligament reconstruction; deep venous thrombosis; knee; prophylaxis; pulmonary embolus; thromboembolic disease.

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram showing the results of application of the study algorithm to the number of studies included, with the number of studies removed after application of each exclusion criterion. ACLR, anterior cruciate ligament reconstruction; VTE, venous thromboembolism.