Incidence Of Deep Venous Thrombosis In Chinese Patients Undergoing Arthroscopic Knee Surgery For Cruciate Ligament Reconstruction: A Prospective Study

Purpose：Deep vein thrombosis is a common disease after total kneeand hip arthroplasty. It is reported that if none preventive measures been donethe DVT occurrence can be40%-84%. The thrombosis is most probablylocated in the calf muscular vein first. But there are few clinical symptoms andsigns, so it is difficult to find. If we do not pay attention to it, the thrombosiswould grow up and affect the main vein in the lower extremity such as thefemoral vein and internal lilac vein. Once emboli shed, it may cause direconsequences for pulmonary embolism. The high incidence of venousthromboembolism (VTE)—which includes deep venous thrombosis andpulmonary embolism—in patients undergoing total hip or knee replacement iswidely acknowledged, and has prompted the development of comprehensiveanticoagulation management guidelines1-4by the medical profession. Withnew technological developments in arthroscopic procedures in recent years,VTE is becoming an ever-increasing concern, although there is limited andconflicting data on its prevalence and effective management. For instance, anincidence between1.5%and17.9%has been reported, and anticoagulationtreatment is not usually prescribed by clinicians after arthroscopic surgery. TheAmerican College of Chest Physicians does not recommend the use ofanticoagulants unless other risk factors are present; nonetheless, DVT isespecially a problem for patients undergoing ligament reconstruction, withseveral reported fatalities from PE following arthroscopy. The clinical reportsrelated to the DVT of arthroscopic cruciate ligament reconstructionpostoperative are relatively fewer aboard and at home, in consideration of that,it is especially important to study and discuss the high risk factors causing theDVT after cruciate ligament reconstruction as well as offer pointed precautionary measures. This paper analyzes the knee cruciate ligamentreconstruction surgery clinical risk factors of deep venous thrombosis byarthoscope.Methods: Between November2009and November2013,564patientswere enrolled in the study who had undergone reconstruction of the anteriorcruciate ligament (ACL), ACL combined with medial and/or lateral collateralligament (MCL and/or LCL, respectively), posterior cruciate ligament (PCL),PCL combined with MCL and/or LCL, or ACL combined with MCL. Allpatients received either spinal or general anesthesia in the supine positionduring the surgery. After a knee examination was performed, a thightourniquet was used on the operated leg; this was deflated for procedureslasting longer than120min, and re-inflated10min later if necessary. For PCLor ACL reconstruction, the single bundle technique combined with allograft orauto-hamstring tendon reconstruction was performed by the same surgeon. Noanticoagulant drugs were provided to the patient postoperatively. All patientswere examined by Color Doppler ultrasound preoperatively and3and7dayspostoperatively. Statistic the incidence of DVT after different surgical methodsand analyzes the relationship between eight clinical factors and DVT.Result: There are564patients in this study, aging from19to45(meanage of patients35.8;370male,194female). DVT was present in68of564patients (12.05%); of these,22(7.23%) underwent reconstruction of theanterior cruciate ligament (ACL) alone; ACL conjunction with the medial orlateral collateral ligament (MCL or LCL, respectively;12.78%);16(17.40%)of the posterior cruciate ligament (PCL); eight (23.52%) of thePCL-MCL/LCL; and ten (25.00%) of the ACL-MCL. In patients withtourniquets applied for <90min,90–120min, and>120min, the incidence ofDVT was5.57%,12.78%, and17.36%, respectively. Univariate x2test showthat BMI≥25kg/m2，TG≥1.7mmol/L，CHOL≥4.0mmol/L, hypertension anddiabetes these six observations relative risk are greater than1.Conclusion: The incidence of DVT in patients undergoing cruciateligament surgery was12.05%. A higher incidence was observed among cases of multi-ligament reconstruction, especially those involving the PCL, as wellas in patients with tourniquets applied for more than2h. Obesity, increase ofthe level of triglycerides and cholesterol, and patients with hypertension ordiabetes also raised possibility the occurrence of DTV. Based on these findings,prophylactic measures for DVT should be adopted during and after ligamentreconstruction surgery.