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Patients undergoing ACL reconstruction at risk for DVT, but may not show symptoms
Study finds 47% DVT risk after arthroscopic ACL surgery in patients older than 30 years.
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FLORENCE — Japanese surgeons identified a 21% rate of deep venous thrombosis in patients after double-bundle arthroscopic ACL reconstruction.
“The incidence of deep venous thrombosis (DVT) in patients 30 years of age or older was significantly higher than in those younger than the age of 30,” according to lead investigator Masayuki Inoue, MD, PhD.
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One reason for such a high incidence: Surgeons did not use pharmacological deep venous thrombosis (DVT) prophylaxis in these patients, but instead used special DVT screening methods, which may have enabled them to better detect thromboembolic events compared to earlier trials.
“Therefore, after common arthroscopic surgery, DVT may occur more frequently than we previously assumed,” Inoue said in presenting the findings at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress, here.
Most of the 11 DVT cases occurred on the operated leg/side. Perhaps surprisingly, “In these patients, 91% of them had no symptoms,” Inoue said.
Specialized ultrasound
Inoue and his colleagues studied 52 patients who underwent arthroscopic ACL reconstruction with an anatomic double-bundle hamstring tendon technique (33 men, 19 women; 15 to 51 years old). They included patients with no history of DVT or previous surgery on the same leg.
Surgeons used an air tourniquet on all patients. Inoue told Orthopaedics Today International that the tourniquet time averaged 89 minutes, ranging from 71 to 130 minutes, and surgical time averaged 99 minutes, ranging from 71 to 150 minutes. None of the patients received pre- or postoperative DVT prophylaxis medicine. Postoperative DVT management consisted only of using foot pumps to increase blood flow for 1 week.
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After 1 week, patients could partially bear weight and do gentle knee exercises. Also at that point, investigators used a specialized Doppler ultrasound technique on all the patients, which combined standard with compression and other ultrasound methods. Their previous research showed it was 98% accurate.
They found no pulmonary emboli, one proximal DVT in a vein peripheral to the popliteal vein (2%) and 10 patients had a distal DVT (19%).
Patients also underwent a physical examination to check for signs of DVT, including swelling, edema and pain.
Caution in older patients
Investigators compared DVT risk factors among patients with and without DVT, including age, D-dimer results, gender, obesity, surgical time and tourniquet time. “DVT occurred in 47% of the patients [who were] 30 years of age or older,” Inoue said.
Other risk factors such as D-dimer, surgery and tourniquet time, gender and body mass index were not significantly different between patients.
According to the study abstract, this is the first report on investigations into DVT symptoms in veins distal to the popliteal after arthroscopic ACL reconstruction.
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Images: Inoue M |
For more information:Reference:
- Masayuki Inoue, MD, can be reached at NTT East Japan Sapporo Hospital, Dept. of Sports Medicine & Joint Reconstruction, Minami-1, Nishi Sapporo, Japan 060-0061; +81-11-623-7001; e-mail: inomasa@rose.ocn.ne.jp. He has no financial conflicts to disclose.
- Inoue M, Taki K, Kaneko S, et al. Risk factor of deep venous thrombosis after arthroscopic ACL reconstruction. #191. Presented at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. May 27-31, 2007. Florence, Italy.