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Anticoagulation Following Anterior Cruciate Ligament Reconstruction

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

The topic of deep vein thrombosis (DVT) prophylaxis in anterior cruciate ligament (ACL) surgery has become an important topic as the frequency of arthroscopic ACL reconstruction continues to increase. The reported incidence of symptomatic DVT following ACL surgery is approximately 0.3 %, and the incidence of pulmonary embolism (PE) is 0.18 %. Several diagnostic tests exist, but ultrasound is most commonly used to diagnose DVT, whereas CT scan is used most frequently to diagnose a PE. Multiple risk factors, both patient and procedure specific, may affect a patient’s overall risk for developing VTE. Patient-specific risk factors include age, gender, previous history of VTE, oral contraceptives or hormone replacement therapy, varicose veins, smoking, obesity, history of malignancy, pregnancy, and an inherited or acquired thrombophilia. Procedure-specific factors include tourniquet time and type of anesthesia. The decision for the right form of thromboprophylaxis for a specific patient starts with proper risk assessment. Commonly used prophylaxis include: sequential compression devices, compression stockings, aspirin, low-molecular-weight heparin, and warfarin. Various guidelines for the selection of appropriate thromboprophylaxis exist, with the most frequently referenced being provided by the American College of Chest Physicians (ACCP). This chapter evaluates the topic of anticoagulation after ACL reconstruction. It will discuss the incidence and diagnosis of DVT, risk factors, and available thromboprophylaxis and highlight available scientific evidence, as well as national and international guidelines.

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Conflicts of Interest and Source of Funding

The authors did not receive any outside funding or grants directly related to the research presented in this manuscript. The authors state that this manuscript is an original work only submitted to this book. The authors hold the rights to all the material presented in this manuscript. All authors contributed to the preparation of this work.

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Authors and Affiliations

  1. Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA, USA

    Carola F. van Eck MD, PhD

  2. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave, Suite, R200, Minneapolis, MN, 55454, USA

    Kelsey Davidson MD & Jeffrey Macalena MD

  3. Artros Center for Orthopaedic Surgery and Sports Medicine, Ljubljana, Slovenia

    Mohsen Hussein MD

  4. Faculty of Medicine, University of Maribor, Maribor, Slovenia

    Mohsen Hussein MD

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  1. Carola F. van Eck MD, PhD
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  2. Kelsey Davidson MD
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  3. Mohsen Hussein MD
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  4. Jeffrey Macalena MD
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Correspondence to Jeffrey Macalena MD .

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Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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van Eck, C.F., Davidson, K., Hussein, M., Macalena, J. (2017). Anticoagulation Following Anterior Cruciate Ligament Reconstruction. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_10

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