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

  • Symposium: Management of the Dislocated Knee
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    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

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  1. Trevor R. Born MD
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  2. William M. Engasser MD
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  3. Alexander H. King
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  5. Diane L. Dahm MD
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Corresponding author

Correspondence to Michael J. Stuart MD.

Additional information

One of the authors (BAL) is a consultant for Arthrex (Naples, FL, USA). One of the authors certifies that he or she (BAL, DLD, MJS) or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 as part of the editorial board for CORR® (Deputy Editor), USD 10,000–100,000 from Arthrex, Inc, and USD 10,000–100,000 from Tenex Health (Lake Forest, CA, USA). One of the authors (BAL) receives research support from Stryker (Mahwah, NJ, USA), Biomet (Warsaw, IN, USA), and Arthrex; and is part of the editorial boards for Arthroscopy (Board of Trustees), Knee Surgery Sports Traumatology and Arthroscopy, and Journal of Knee Surgery. One of the authors (MJS) is a consultant for Arthrex and receives research support from Stryker and the USA Hockey Foundation.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Born, T.R., Engasser, W.M., King, A.H. et al. Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis. Clin Orthop Relat Res 472, 2705–2711 (2014). https://doi.org/10.1007/s11999-014-3576-z

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