Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review.
OBJECTIVE
To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction.


METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined.


RESULTS
Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism.


CONCLUSIONS
After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, 5600PD, Eindhoven, The Netherlands.
Rob Paulus Augustinus
RP
Janssen
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, 5600PD, Eindhoven, The Netherlands.
Max
M
Reijman
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, 5600PD, Eindhoven, The Netherlands.
Daan Martijn
DM
Janssen
Rob Paulus Augustinus Janssen, Max Reijman, Daan Martijn Janssen, Jan Bernardus Antonius van Mourik, Department of Sports Medicine and Orthopaedic Surgery, Máxima Medical Center, 5600PD, Eindhoven, The Netherlands.
Jan Bernardus Antonius
JB
van Mourik
Anterior cruciate ligament reconstruction; Arterial complication; Pseudoaneurysm; Pulmonary embolism; Thromboprophylaxis; Venous thromboembolism
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