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Yazdi H, Eslami A, Torkaman A, Elahifar O, Kasaeian A, Alimoghadam S, Alimoghadam R, Abolghasemian M. Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:154. [PMID: 38373950 PMCID: PMC10875785 DOI: 10.1186/s12891-024-07282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hamidreza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Torkaman
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Diseases Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaya Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Rojina Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
- University of Alberta, Alberta, Canada.
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Bonfim LCMG, Sporer ME, Poeta L, Carvalho GRR, Bertelli JA. Complete tibial nerve lesion secondary to postoperative popliteal pseudoaneurysm following anterior cruciate ligament arthroscopic reconstruction: A series of two patients. Surg Neurol Int 2023; 14:409. [PMID: 38213440 PMCID: PMC10783661 DOI: 10.25259/sni_570_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/14/2023] [Indexed: 01/13/2024] Open
Abstract
Background Complications following arthroscopic anterior cruciate ligament reconstruction (ACLR) are rare, but injuries to the popliteal artery can occur. Popliteal pseudoaneurysms are a potential complication and can cause significant morbidity if not diagnosed and treated promptly. Cases Description We describe the cases of two patients who developed nerve injuries following arthroscopic ACLR, with subsequent diagnosis of a popliteal pseudoaneurysm. The peroneal nerve recovered spontaneously in both cases, while the tibial nerve was reconstructed using autologous nerve grafting. Satisfying, functional recoveries were observed 24 months postoperatively. Conclusion Prompt diagnosis and effective treatment of popliteal pseudoaneurysms are crucial to prevent further complications. However, timely diagnosis can be challenging due to inconsistent clinical presentations and a low index of suspicion. This case report highlights the need for increased awareness of this uncommon complication and provides insights into its pathophysiological mechanisms.
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Affiliation(s)
| | - Matthias E. Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Laura Poeta
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianopolis, Brazil
| | | | - Jayme A. Bertelli
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianopolis, Brazil
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3
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Kanaya H, Enokida M, Ishida K, Yamashita T, Nagashima H. Factors associated with perioperative deep vein thrombosis in arthroscopic anterior cruciate ligament reconstruction. J Orthop Sci 2023; 28:1041-1045. [PMID: 35842268 DOI: 10.1016/j.jos.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/29/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is reportedly associated with a higher incidence of deep vein thrombosis (DVT) incidence than other arthroscopic surgical procedures. The aim of this study is to retrospectively investigate the incidence and type of DVT and evaluate the relationship between DVT and risk factors among all patients who underwent ACLR under uniform conditions consisting of mechanical prophylaxis, no medical prophylaxis, and preoperative and postoperative lower extremity venous ultrasonography. METHODS Of the 114 patients who underwent arthroscopic primary ACLR at our hospital who did not have a compound ligament injury or revision surgery, 112 patients were included. Two patients were not examined. DVT evaluation consisted of whole-leg ultrasonography at 1 week after surgery. We evaluated age, sex, body mass index, comorbidities, operative time, tourniquet time, presence of concurrent surgery (meniscus repair/resection or osteochondral column grafting), and non-weight-bearing status at 1 week after surgery as risk factors for DVT. RESULTS DVT was found in 33 (29.5%) of 112 patients. Of these, 22 (19.6%) had distal DVT and 11 (9.8%) had proximal DVT. Non-weight-bearing status at 1 week after surgery was a statistically significant risk factor for proximal DVT (P = .034). CONCLUSIONS Non-weight-bearing status is an independent risk factor for DVT, suggesting that early weight bearing may reduce the occurrence of DVT.
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Affiliation(s)
- Haruhisa Kanaya
- Department of Orthopedic Surgery, Tottori University, 36-1 Nishicho, Yonago City, Tottori, 683-8504, Japan.
| | - Makoto Enokida
- Sports Medical Center, Tottori University, 36-1 Nishicho, Yonago City, Tottori, 683-8504, Japan.
| | - Koji Ishida
- Department of Orthopedic Surgery, Tottori University, 36-1 Nishicho, Yonago City, Tottori, 683-8504, Japan.
| | - Takahiro Yamashita
- Department of Orthopedic Surgery, Tottori University, 36-1 Nishicho, Yonago City, Tottori, 683-8504, Japan.
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Tottori University, 36-1 Nishicho, Yonago City, Tottori, 683-8504, Japan.
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Aslani H, Bonakdar S, Amoozade F, Gorji M, Gholami AH, Tajic K, Gholipour M. The Effect of Lower Limb Position on Anterior Cruciate Ligament Reconstruction on Uncommon Complications after Surgery. Adv Biomed Res 2023; 12:204. [PMID: 37694238 PMCID: PMC10492626 DOI: 10.4103/abr.abr_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 09/12/2023] Open
Abstract
Background To reduce the complications of orthopedic surgery, the desire for less invasive procedures, such as, knee arthroscopy to repair the anterior cruciate ligament, has increased. There are, currently, two common positions for limbs that are used during surgery depending on the surgeon's experience. Therefore, our aim was to investigate the effect of limb position on complications after anterior cruciate ligament reconstruction surgery. Materials and Methods From April 2016 to July 2020 at our orthopedic-sports trauma center, 688 patients between the ages of 18 and 50 with anterior cruciate ligament rupture underwent reconstruction surgery with a hamstring graft. Patients were divided into two groups in terms of limb position at the time of surgery. For three months, patients were evaluated for surgical complications, basic demographic information, and information during surgery. Results There was no statistically significant difference between the two groups in terms of demographic information, side of injury, preparation time, tourniquet time, operation time, and duration of hospitalization. At quarterly follow-up, there was no significant difference between the two groups in terms of postoperative complications (P = 0.976). Conclusions There is no difference between compartment syndrome and deep vein thrombosis in different situations, therefore, the surgeon should operate in any position he is skilled in. Also, surgeons should always pay special attention to these complications and provide necessary training to patients in order to prevent them.
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Affiliation(s)
- Hamidreza Aslani
- Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran
| | - Sona Bonakdar
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Farzad Amoozade
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mona Gorji
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir H. Gholami
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Katayoun Tajic
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Morteza Gholipour
- Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
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Hashimoto Y, Komiya E, Nishino K, Nishida Y, Masuda A, Nakamura H. Postoperative D-dimer levels predict venous thromboembolisms detected with contrast-enhanced computerized tomography in patients undergoing anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2023; 24:95. [PMID: 36740690 PMCID: PMC9901121 DOI: 10.1186/s12891-023-06212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/31/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In the literature, factors associated with postoperative venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) are limited. This study aimed to investigate the incidence of venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) and to identify risk and predictive factors for VTEs. METHODS This retrospective study included 136 patients who underwent arthroscopic ACLR with mechanical prophylaxis between April 2012 and July 2022. Contrast-enhanced computed tomography (CT) was applied to detect VTEs comprising deep venous thromboses and pulmonary embolisms 7 days after surgery. Data including age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were collected for analyses. The incidence of radiographically confirmed VTEs and the associated risk factors, such as age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were analyzed. RESULTS The overall incidence of radiographic VTEs was 11.0% (15 cases) in 136 patients. There was one symptomatic patient who had Homan's sign. Multivariable analysis indicated that postoperative D-dimer level was an independent factor related to a radiographic VTE after ACLR, although there was no association between radiographic VTEs and preoperative status or operation status. The optimal cutoff value for postoperative D-dimer level was 2.8 μg/ml according to the receiver operating characteristic curve analysis, with a sensitivity of 80.0% and specificity of 83.5%. CONCLUSION The incidence of ACLR-associated radiographical VTEs (deep venous thrombosis and pulmonary embolism) under mechanical prophylaxis was 11.0% in this study. An elevated D-dimer level at 7 days after surgery is an independent predictor of VTE in patients undergoing ACLR. The postoperative D-dimer level is a more reliable marker for identifying VTE in patients who underwent ACLR.
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Affiliation(s)
- Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Eriko Komiya
- grid.261445.00000 0001 1009 6411Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- grid.261445.00000 0001 1009 6411Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- grid.416618.c0000 0004 0471 596XDepartment of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Atsushi Masuda
- grid.258799.80000 0004 0372 2033Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
| | - Hiroaki Nakamura
- grid.258799.80000 0004 0372 2033Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585 Japan
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Xiong Y, Li X, Lei G, Zeng C, Wei J, Ding X, Li H. Anterior cruciate ligament tear increases the risk of venous thromboembolism: a population-based cohort study. Knee Surg Sports Traumatol Arthrosc 2022; 31:1805-1814. [PMID: 35984447 DOI: 10.1007/s00167-022-07097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Previous studies highlighted an increased risk of venous thromboembolism (VTE) among patients with anterior cruciate ligament reconstruction (ACLR); however, the risk for those with ACL tear but without undergoing ACLR has not been reported yet. The aim of this study was to evaluate the risk of VTE among ACL tear individuals with or without ACLR derived from the general population. METHODS A cohort study was conducted using data from the IQVIA Medical Research Database of the United Kingdom. Up to five non-ACL tear individuals (n = 22,235) were matched to each case of ACL tear (n = 4474) by age, sex, body mass index and entry-time. The relation of ACL tear to VTE [pulmonary embolism (PE) and deep vein thrombosis (DVT)] was examined using a multivariable Cox proportional hazard model. A sub-cohort analysis, in which the ACL tear individuals were stratified into those with ACLR and those without ACLR, was also conducted. RESULTS VTE developed in 13 individuals with ACL tear and nine individuals without ACL tear (incidence rates: 3.1 vs. 0.4/1000 person-years), with multivariable-adjusted hazard ratio (HR) being 6.59 (95% CI 2.28-19.08) in 1-year follow-up. For ACL tear individuals with ACLR, the HR was 11.44 (95% CI 2.71-48.28), and for those without ACLR, the HR was 6.02 (95% CI 1.44-24.25), compared with individuals without ACL tear. CONCLUSION This large-sample population-based cohort study provides the first evidence on an increased risk of VTE in ACL tear individuals regardless of subsequent ACLR, which supports the necessity for monitoring venous-thromboembolic complications in the target population, including those without ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yilin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1552-1559. [PMID: 33970293 DOI: 10.1007/s00167-021-06583-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE To determine the incidence of symptomatic venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction using a large national database and to identify corresponding independent risk factors. METHODS The Humana administrative claims database was reviewed for patients undergoing ACL reconstruction from 2007 to 2017. Patient demographics, medical comorbidities, as well as concurrent procedures were recorded. Postoperative incidence of VTE was measured by identifying symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) at 30 days, 90 days, and 1 year postoperatively. Univariate analysis and binary logistic regression were performed to determine independent risk factors for VTE following surgery. RESULTS A total of 11,977 patients were included in the study. The incidence of VTE was 1.01% (n = 120) and 1.22% (n = 146) at 30 and 90 days, respectively. Analysis of VTE events within the first postoperative year revealed that 69.6% and 84.3% of VTEs occurred within 30 and 90 days of surgery, respectively. Logistic regression identified age ≥ 45 (odds ratio [OR] = 1.88; 95% confidence interval [CI] 1.32-2.68; p < 0.001), inpatient surgery (OR = 2.07; 95% CI 1.01-4.24; p = 0.045), COPD (OR = 1.51; 95% CI 1.02-2.24; p = 0.041), and tobacco use (OR = 1.75; 95% CI 1.17-2.62; p = 0.007), as well as concurrent PCL reconstruction (OR = 3.85; 95% CI 1.71-8.67; p = 0.001), meniscal transplant (OR = 17.68; 95% CI 3.63-85.97; p < 0.001) or osteochondral allograft (OR = 15.73; 95% CI 1.79-138.43; p = 0.013) as independent risk factors for VTE after ACL reconstruction. CONCLUSIONS The incidence of symptomatic postoperative VTE is low following ACL reconstruction, with the majority of cases occurring within 90 days of surgery. Risk factors include age ≥ 45, inpatient surgery, COPD, tobacco use and concurrent PCL reconstruction, meniscal transplant or osteochondral allograft. LEVEL OF EVIDENCE III.
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8
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Incidence and Prevention of Thromboembolic Complications for Sports and Arthroscopic-related Surgery: Evidence-based Recommendations. Sports Med Arthrosc Rev 2022; 30:24-28. [PMID: 35113839 DOI: 10.1097/jsa.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of thromboembolic events following arthroscopic surgery is relatively rare. Despite this, these are important complications to be aware of, as arthroscopic procedures are performed in high frequency each year and can lead to a substantial burden within health care. Over the past several decades, pharmacologic antithrombotic prevention strategies following knee arthroscopy have been extensively studied; however, their efficacy remains controversial, and there is a lack of consensus regarding a standard prevention protocol, with the exception of the established benefits of early mobilization. Several surgical and medical risk factors have been established and are important to consider as they specifically relate to each individual patient's risk of thromboembolic disease. Based on the best available evidence, chemical thromboprophylaxis appears to be unnecessary among healthy patients but may be beneficial for higher risk patients, especially those with a prior history of venous thromboembolism. A standard screening tool for risk factors in arthroscopy patients may be a cost-effective and safe solution for implementing preventative efforts.
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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McIntire SC, Bernstein EM, Tompane TM, Briggs AM, Ferris WJ, Renninger CH, McDonald LS, Hurvitz AP. Aspirin for Deep-Venous Thrombosis Prophylaxis After Anterior Cruciate Ligament Reconstruction. Mil Med 2021; 186:656-660. [PMID: 33538827 DOI: 10.1093/milmed/usab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
AIM To evaluate whether a daily full-dose aspirin regimen after anterior cruciate ligament (ACL) reconstruction reduces the risk of postoperative symptomatic deep-venous thrombosis (DVT). MATERIALS AND METHODS Single-center retrospective cohort study of patients who underwent ACL reconstruction from 2007 to 2016. One thousand two hundred thirty-three patients met inclusion criteria: 821 patients received no chemoprophylaxis and 412 patients received daily full-dose aspirin. RESULTS A total of 10 patients, seven receiving no chemoprophylaxis and three using aspirin, sustained a postoperative symptomatic DVT. Calculated adjusted odds ratio for symptomatic postoperative DVT for aspirin versus no chemoprophylaxis was 0.928 (95% CI 0.237-3.629, P value = 0.91). Odds ratio for symptomatic postoperative DVT occurrence among tobacco users versus non-tobacco users was 3.76 (95% CI 1.077-13.124, P = 0.04). CONCLUSIONS No statistically significant difference was observed in postoperative symptomatic DVT after ACL reconstruction in those who received full-dose aspirin chemoprophylaxis versus those with no chemoprophylaxis. Additionally, there was a significantly increased risk of postoperative symptomatic DVT with tobacco use.
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Affiliation(s)
- Sean C McIntire
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Ethan M Bernstein
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Trevor M Tompane
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Avery M Briggs
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - William J Ferris
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | | | - Lucas S McDonald
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Andrew P Hurvitz
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
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11
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Liu X, Tan AHC. Incidence of venous thromboembolism in Asian patients undergoing anterior cruciate ligament reconstruction without the use of mechanical or chemical prophylaxis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/2210491721994314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Venous thromboembolism (VTE) is a clinically relevant complication of major orthopedic surgeries. The prevalence of VTE and the indications for VTE thromboprophylaxis in Asian patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction are not clear. This study aims to evaluate the prevalence of clinically significant venous thromboembolic events (VTE) in Asian patients undergoing arthroscopic ACL reconstruction without mechanical or chemical thromboprophylaxis. Methods: All patients who underwent ACL reconstruction by a single surgeon from 2006 to 2018 in a single tertiary institution were reviewed. The inclusion criteria for the study included Asian patients of common ethnic groups in Singapore (Chinese, Malay, Indian) and underwent primary or revision ACL reconstruction, or ACL reconstruction combined with meniscal surgery. The exclusion criteria were patients with incomplete medical records, pre-existing anticoagulant treatment within 1 year prior to the surgery and additional procedures that altered the standard rehabilitation protocol, less than 6 months of follow-up duration. All patients received general anesthesia. The single-bundle ACL technique with autologous hamstring tendon reconstruction was performed. No chemical DVT prophylaxis was given. The patients were screened for clinically for VTE. Symptomatic patients were referred for ultrasonography. Results: Of the 581 patients reviewed, 3 patients had a clinical suspicion of deep vein thrombosis, but subsequent ultrasonography showed no thrombosis. Hence, the prevalence of clinically significant VTE was 0%. Conclusion: Given the low prevalence of clinically significant VTE, there is no need for routine mechanical or chemical thromboprophylaxis or radiologic screening in Asian patients undergoing arthroscopic ACL reconstruction.
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Affiliation(s)
- Xuan Liu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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12
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Samama CM, Rosencher N, Laporte S, Girard P. Preventing venous thrombo-embolism after nonmajor orthopedic surgery. Trends Cardiovasc Med 2020; 31:507-511. [PMID: 33152449 DOI: 10.1016/j.tcm.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
The venous thromboembolism risk is low to moderate in nonmajor orthopedic surgery. The literature is unconclusive. New emerging data are now available. The global patient risk has to be taken into account to determine the need for any prophylaxis.
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Affiliation(s)
- Charles Marc Samama
- Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP, Centre - Université de Paris - Cochin Hospital, 27 rue du Faubourg St Jacques, 75014 Paris, France.
| | - Nadia Rosencher
- Department of Anaesthesia, Intensive Care and Perioperative Medicine, GHU AP-HP, Centre - Université de Paris - Cochin Hospital, 27 rue du Faubourg St Jacques, 75014 Paris, France
| | - Silvy Laporte
- SAINBIOSE U1059, Univ Lyon, UJM-Saint-Etienne, F-42023 Saint-Etienne, France; Unité de Recherche Clinique, Innovation, Pharmacologie, Centre Hospitalier Universitaire de Saint-Etienne, Inserm CIE1408, F-CRIN INNOVTE Network, Paris, France
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 75014 Paris, France; F-CRIN INNOVTE Network, Paris, France
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Conventional Follow-up Versus Mobile Application Home Monitoring for Postoperative Anterior Cruciate Ligament Reconstruction Patients: A Randomized Controlled Trial. Arthroscopy 2020; 36:1906-1916. [PMID: 32268161 DOI: 10.1016/j.arthro.2020.02.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether a mobile app can reduce the need for in-person visits and examine the resulting societal cost differences between mobile and conventional follow-up for postoperative anterior cruciate ligament (ACL) reconstruction patients. METHODS Study design was a single-center, 2-arm parallel group randomized controlled trial. All patients undergoing ACL reconstruction aged 16 to 70 years were screened for inclusion in the study. Competent use of a mobile device and ability to communicate in English was required. Patients were randomly assigned to receive follow-up via a mobile app or conventional appointments. Analysis was intention-to-treat. The primary outcome was the number of in-person visits to any health care professional during the first 6 postoperative weeks. Secondary outcomes included analysis of costs incurred by the health care system and personal patient costs related to both methods of follow-up. Patient-reported satisfaction and convenience scores, rates of complications, and clinical outcomes were also analyzed. RESULTS Sixty patients were analyzed. Participants in the app group attended a mean of 0.36 in-person visits versus 2.44 in-person visits in the conventional group (95% confidence interval 0.08-0.28; P < .0001). On average, patients in the app group spent $211 (Canadian dollars) less than the conventional group over 6 weeks (P < .0001) on personal costs related to follow-up. Health care system costs were also significantly less in the app group ($157.5 vs CAD $202.2; P < .0001). There was no difference between groups in patient satisfaction, convenience, complication rates, or clinical outcome measures. CONCLUSIONS Mobile follow-up can eliminate a significant number of in-person visits during the first 6 postoperative weeks in patients undergoing ACL reconstruction with cost savings to both the patient and health care system. This method should be considered for dissemination among similar orthopaedic procedures during early postoperative care. LEVEL OF EVIDENCE I: Prospective randomized controlled trial.
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14
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Theodorides AA, Wall OR. Two-stage revision anterior cruciate ligament reconstruction: Our experience using allograft bone dowels. J Orthop Surg (Hong Kong) 2020; 27:2309499019857736. [PMID: 31232200 DOI: 10.1177/2309499019857736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of anterior cruciate ligament reconstruction (ACLR) is continuously increasing. As a result so has the need for revision ACLR, which unfortunately has worse functional outcomes and rate of return to sport. Revision ACLR can be performed as a single stage or in two stages. The latter is recommended in the presence of enlarged and/or malpositioned tunnels. We describe our surgical technique, experience and outcome of our first 19 patients in whom we used allograft bone dowels in the first stage of revision ACLR.
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Affiliation(s)
| | - Owen R Wall
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
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15
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Ekdahl V, Stålman A, Forssblad M, Samuelsson K, Edman G, Kraus Schmitz J. There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction: a nation-wide survey of ACL surgeons in Sweden. Knee Surg Sports Traumatol Arthrosc 2020; 28:2535-2542. [PMID: 32025765 PMCID: PMC7429518 DOI: 10.1007/s00167-020-05851-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons' individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed. METHODS Questionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use of a tourniquet during surgery. The responses were assessed for agreement and the thromboprophylaxis data were analysed in relation to the 2016 SKLR data. RESULTS 115 (75%) ACL surgeons responded to the survey. 81.7% prescribed thromboprophylaxis only when risk factors, such as history of thrombosis and the use of oral contraceptives, were present. Female gender, older age and admitted patient were considered the risk factors with the lowest impact. The respondents were generally restrictive regarding the use of prolonged antibiotic prophylaxis. The use of vancomycin-soaked graft was used by only nine (8%) surgeons representing 406 (13%) of the surgeries. CONCLUSION Swedish ACL surgeons are generally restrictive using thromboprophylaxis and only when risk factors are present. However, there is a lack of consensus in how to weigh the different risk factors and it does not completely adhere to the existing literature. Prolonged antibiotic prophylaxis is rarely used and the use of vancomycin soaking of graft is very limited and applies only to a small number of surgeons. The use of tourniquet is common. There is a need for ACL-specific guidelines regarding the use of thromboprophylaxis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Victor Ekdahl
- grid.4714.60000 0004 1937 0626Karolinska Institutet, Stockholm, Sweden
| | - Anders Stålman
- grid.4714.60000 0004 1937 0626Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,Capio Artro Clinic, Stockholm, Sweden
| | - Magnus Forssblad
- grid.4714.60000 0004 1937 0626Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Samuelsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clincial Sciences, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Edman
- grid.4714.60000 0004 1937 0626Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Kraus Schmitz
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
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16
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Abram SGF, Judge A, Beard DJ, Price AJ. Rates of Adverse Outcomes and Revision Surgery After Anterior Cruciate Ligament Reconstruction: A Study of 104,255 Procedures Using the National Hospital Episode Statistics Database for England, UK. Am J Sports Med 2019; 47:2533-2542. [PMID: 31348862 DOI: 10.1177/0363546519861393] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After an anterior cruciate ligament (ACL) injury, ACL reconstruction is an elective procedure, and therefore, an understanding of the attributable risk from undergoing ACL reconstruction is necessary for patients to make a fully informed treatment decision. PURPOSE To determine the absolute risk of adverse outcomes including reoperation after ACL reconstruction with comparison, where possible, to the rate of adverse events reported in the general population. STUDY DESIGN Descriptive epidemiology study. METHODS National hospital data on all ACL reconstructions performed in England between April 1, 1997, and March 31, 2017, were analyzed. Revision cases, bilateral procedures within 6 months, and cases with concurrent cartilage or multiple ligament surgery were excluded. The primary outcome was the occurrence of at least 1 serious complication (myocardial infarction, stroke, pulmonary embolism, infection requiring surgery, fasciotomy, neurovascular injury, or death) within 90 days. Additionally, 5-year rates of revision ACL reconstruction, contralateral ACL reconstruction, and meniscal surgery were investigated. RESULTS There were 133,270 ACL reconstructions performed, of which 104,255 were eligible for analysis. Within 90 days, serious complications occurred in 675 (0.65% [95% CI, 0.60-0.70]), including 494 reoperations for infections (0.47% [95% CI, 0.43-0.52]) and 129 for pulmonary embolism (0.12% [95% CI, 0.10-0.15]). Of 54,275 procedures with at least 5 years' follow-up, 1746 (3.22% [95% CI, 3.07-3.37]) underwent revision ACL reconstruction in the same knee, 1553 underwent contralateral ACL reconstruction (2.86% [95% CI, 2.72-3.01]), and 340 underwent meniscal surgery (0.63% [95% CI, 0.56-0.70]). The overall risk of serious complications fell over time (adjusted odds ratio [OR], 0.96 per year [95% CI, 0.95-0.98]); however, older patients (adjusted OR, 1.11 per 5 years [95% CI, 1.07-1.16]) and patients with a greater modified Charlson Comorbidity Index (adjusted OR, 2.41 per 10 units [95% CI, 1.65-3.51]) were at a higher risk. For every 850 (95% CI, 720-1039) ACL reconstructions, 1 pulmonary embolism could be provoked. For every 213 (95% CI, 195-233), 1 native knee joint infection could be provoked. CONCLUSION The overall risk of adverse events after ACL reconstruction is low; however, some rare but serious complications, including infections or pulmonary embolism, may occur. Around 3% of patients undergo further ipsilateral or contralateral ACL reconstruction within 5 years. These data will inform shared decision making between clinicians and patients considering their treatment options.
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Affiliation(s)
- Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK.,Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
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17
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Preuss FR, Hadeed MM, Weiss DB. Delayed vascular complications after orthopaedic surgery: A report of two cases and review of the literature. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1016/j.jotr.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Vascular complications from orthopaedic surgery can be devastating. Arteriovenous fistula (AVF) and pseudoaneurysm formation are possible from orthopaedic injuries as well as orthopaedic surgery. Limbthreatening complications of vascular malformation include ischaemia, ulceration, haemorrhage, and gangrene potentially requiring amputation. Although rare, these vascular malformations should remain on the differential diagnosis for any patient not following the typical postoperative course. When presented with these case, and repair is recommended, it should be coordinated between orthopaedic and vascular surgeons. Review of the literature indicates that the risk of AVF and pseudoaneurysm formation remains underappreciated, particularly in the subacute and chronic setting. Theoretically, minimally invasive procedures with drilling near vessels increases the chances of vascular injury that goes unnoticed during the index procedure. This report of two cases discusses diagnosis and repair of pseudoaneurysm and AVF. It is a cautionary warning to consider these vascular injuries as late-presenting, limbthreatening complications of orthopaedic surgery.
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Affiliation(s)
- Fletcher R. Preuss
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Michael M. Hadeed
- University of Virginia Health System, Department of Orthopaedic Surgery, Charlottesville, VA, USA
| | - David B. Weiss
- University of Virginia Health System, Department of Orthopaedic Surgery, Charlottesville, VA, USA
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18
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Liu Z, Li Y, Ren Y, Jin Y, Yang J, Wang S, Zhu X, Xiong H, Zou G, Liu Y, Huang W. Enhancement of in vitro proliferation and bioactivity of human anterior cruciate ligament fibroblasts using an in situ tissue isolation method and basic fibroblast growth factor culture conditions: A pilot analysis. Medicine (Baltimore) 2019; 98:e15907. [PMID: 31145353 PMCID: PMC6708876 DOI: 10.1097/md.0000000000015907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have reported poor proliferation and bioactivity of human anterior cruciate ligament fibroblasts (hACLFs) after injury. As hACLFs are one of the most significant and indispensable source of seed cells in constructing tissue-engineered ligament, enhancing hACLF proliferation would offer favorable cellular-biological ability and induce the extracellular matrix secretion of hACLFs after loading on multiple types of scaffolds. Enhancing the bioactivity of hACLFs would improve tissue repair and functional recovery after tissue-engineered ligament transplantation. This study compared cells prepared by collagenase digestion and the in situ culture of tissue pieces and investigated the effect of basic fibroblast growth factor (bFGF) on hACLFs. METHODS Six adult patients participated in this study. Of these patients, tissues from three were compared after culture establishment through collagenase digestion or in situ tissue isolation. hACLF phenotypic characteristics were assessed, and the effect of bFGF on hACLF cultures was observed. hACLFs cultured with and without bFGF served as the experimental and control groups, respectively. Cell Counting Kit-8 was used to detect proliferation. The expression of ligament-related genes and proteins was evaluated by immunofluorescence staining, real-time polymerase chain reaction (PCR) assays, and Western blot assays. RESULTS The morphology of hACLFs isolated using the two methods differed after the 2nd passage. The proliferation of cells obtained by in situ culture was higher than that of cells obtained by collagenase digestion. hACLFs cultured with bFGF after the 3rd passage exhibited a higher proliferation rate than the controls. Immunofluorescence staining, real-time PCR, and Western blot analysis showed a significant increase in ligament-related gene and protein expression in the hACLFs cultured with bFGF. CONCLUSIONS The in situ isolation of tissue pieces enhanced hACLF proliferation in vitro, and the hACLFs exhibited phenotypic characteristics of fibroblasts. hACLFs cultured with bFGF exhibited increased hACLF bioactivity.
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Affiliation(s)
- Ziming Liu
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
| | - Yuwan Li
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
| | - Youliang Ren
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Ying Jin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Jibin Yang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Shengmin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Xizhong Zhu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Huazhang Xiong
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Gang Zou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Yi Liu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Wei Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
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19
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Bohl DD, Verma NN, Forsythe B. Effect of Operative Time on Short-Term Adverse Events After Isolated Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967118825453. [PMID: 31001565 PMCID: PMC6454657 DOI: 10.1177/2325967118825453] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: A longer operative time has been previously recognized as a risk factor for
short-term complications after various orthopaedic procedures; however, it
has yet to be investigated as an independent risk factor for postoperative
complications after anterior cruciate ligament (ACL) reconstruction. Purpose: To identify whether a longer operative time in ACL reconstruction is an
independent risk factor for the development of postoperative complications,
hospital readmissions, or an extended length of stay within 30 days of the
index procedure. Study Design: Descriptive epidemiology study. Methods: Patients undergoing ACL reconstruction between 2005 and 2016 were identified
using the American College of Surgeons National Surgical Quality Improvement
Program (ACS-NSQIP) database. Cases with concomitant procedures were
excluded from the analysis. We evaluated the association between operative
time and preoperative variables such as patient age, sex, body mass index,
comorbidities, and procedure. Correlations between adverse events and
operative time, while controlling for the above preoperative variables, were
calculated using multivariate Poisson regression with robust error
variance. Results: A total of 14,159 procedures were included in this investigation. The mean
patient age was 32.6 ± 10.8 years, the mean body mass index was 27.7 ± 6.5
kg/m2, and the mean operative time was 89.7 ± 28.6 minutes.
Patients who were between the ages of 18 and 30 years (mean operative time,
95.1 ± 27.8 minutes; relative risk [RR], 17.7; P <
.001), male (mean operative time, 91.9 ± 28.3 minutes; RR, 4.7;
P < .001), and nondiabetic (mean operative time,
89.8 ± 28.6 minutes; RR, 7.1; P = .011) were associated
with a longer operative duration. The overall complication rate was 1.1%.
After adjusting for demographic characteristics and procedures, 15-minute
incremental increases in operative duration were associated with an
increased risk of deep vein thrombosis (RR, 1.12; P =
.042), surgical site infections (RR, 1.21; P = .001), and
sepsis (RR, 1.66; P < .001) as well as increased
readmission rates (RR, 1.23; P = .001) and an extended
length of stay (RR, 1.18; P = .008). Conclusion: While the overall adverse risk rate after ACL reconstruction remains low,
marginal increases in operative time are associated with an increased risk
of adverse events such as deep vein thrombosis, surgical site infections,
sepsis, an extended length of stay, and readmissions. Thus, the operating
physician and surgical staff should make all efforts to coordinate and
prepare for each case to maximize surgical efficiency.
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Affiliation(s)
- Avinesh Agarwalla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Daniel D Bohl
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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20
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Koaban S, Alatassi R, Ahmed B, Alogayyel N. Bilateral pulmonary embolism after arthroscopic anterior cruciate ligament reconstruction: A case report. Int J Surg Case Rep 2018; 49:64-66. [PMID: 29966950 PMCID: PMC6039889 DOI: 10.1016/j.ijscr.2018.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/15/2018] [Accepted: 06/22/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Venous thromboembolism is a serious complication in orthopedic surgery. It is very common in major surgery, such as total hip arthroplasty. However, few reports have described the incidence of pulmonary embolism and its associated risk factors following less invasive surgery, such as arthroscopic knee surgery. PRESENTATION OF CASE We describe a rare presentation of a young man with bilateral pulmonary embolism of the main pulmonary arteries following arthroscopic anterior cruciate ligament reconstruction. DISCUSSION The present patient is different from other similar cases in that he was an active healthy man without any risk factors for the development of thrombosis. Despite this, he experienced a bilateral pulmonary embolism one week after knee arthroscopy. CONCLUSION Although anterior cruciate ligament reconstruction is a common and safe procedure performed on a daily basis, unexpected complications may occur. One of these is venous thromboembolism which may be fatal.
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Affiliation(s)
- Saeed Koaban
- Security Forces Hospital, Department of Orthopedic Surgery, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia.
| | - Raheef Alatassi
- Security Forces Hospital, Department of Orthopedic Surgery, P.O. Box: 3643, Riyadh, 11481, Saudi Arabia.
| | - Bandar Ahmed
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, P.O. Box: 22490, Riyadh, 11426, Saudi Arabia.
| | - Nawaf Alogayyel
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, P.O. Box: 22490, Riyadh, 11426, Saudi Arabia.
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21
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Bokshan SL, DeFroda SF, Panarello NM, Owens BD. Risk Factors for Deep Vein Thrombosis or Pulmonary Embolus Following Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118781328. [PMID: 29977948 PMCID: PMC6024540 DOI: 10.1177/2325967118781328] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Nearly 350,000 Americans develop a deep venous thromboembolism (DVT) or pulmonary embolism (PE) annually, and nearly 100,000 Americans die from these events. To date, little research has investigated patient-specific risk factors that increase the rate of DVT/PE following anterior cruciate ligament reconstruction (ACLR). Purpose: To determine relevant patient risk factors for the development of DVT/PE following ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All instances of ACLR from 2005 to 2014 within the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospective database were analyzed. Both univariate analysis and binary logistic regression were performed to determine which patient demographics and surgical factors were associated with DVT or PE following surgery. Results: Of the 9146 patients who underwent ACLR, 46 (0.5%) developed postoperative DVT, 8 (0.1%) developed PE, and 5 (0.05%) developed both. The following variables were associated with the development of DVT or PE on univariate analysis: increased age, a high tibial osteotomy (HTO) performed at the time of ACLR, microfracture performed, the presence of hypertension requiring medical therapy, and the presence of an active wound infection. Independent predictors of DVT or PE on multivariate analysis included HTO (odds ratio [OR], 22.7), the presence of an active wound infection (OR, 11.0), or hypertension requiring medication (OR, 2.2). Meniscal repair was not a risk factor for DVT or PE on univariate or multivariate analysis. Conclusion: In a review of 9146 patients undergoing ACLR, 46 (0.5%) developed DVT in the 30-day postoperative period. Increasing age over 30 years, concomitant HTO or microfracture, hypertension requiring medication, and presence of wound infection were all associated with an increased risk of DVT. The annual incidence of DVT/PE following ACLR reconstruction is low (<1%) and has not changed over time.
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Affiliation(s)
- Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Nicholas M Panarello
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA.,Department of Sports Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, USA
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22
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Zheng G, Tang Q, Shang P, Pan XY, Liu HX. No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: a systemic review and meta-analysis of randomized controlled trials. J Thromb Thrombolysis 2018; 45:562-570. [PMID: 29549559 DOI: 10.1007/s11239-018-1638-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Arthroscopic knee surgery is the most commonly performed orthopedic procedure worldwide and whether thromboprophylaxis should be undertaken after knee arthroscopy is still controversial. To evaluate the efficacy of thromboprophylaxis for deep venous thrombosis (DVT) and venous thromboembolism (VTE) after knee arthroscopic surgery. A meta-analysis was conducted using data from eight randomized trials (4148 patients) to compare thromboprophylaxis with placebo or no prophylactic treatment in patients undergoing knee arthroscopy. The benefits and harms of thromboprophylaxis were evaluated, including the incidence of asymptomatic DVT, symptomatic VTE, pulmonary embolism and anti-coagulation related adverse events. Thromboprophylaxis significantly decreased the incidence of DVT (95% CI 0.07-0.64, P = 0.006) and symptomatic VTE in patients undergoing knee arthroscopy (95% CI 0.23-0.76, P = 0.004), but not significantly decreased the incidence of pulmonary embolism (n.s.). Regarding to non-major knee arthroscopy surgery (simple surgical procedures without ligament reconstruction), no significant difference of the incidence of DVT or symptomatic VTE was noted between thromboprophylactic group and control group (n.s.). Thromboprophylactic treatment showed higher incidence rate of anti-coagulation related adverse events compared with the control group (95% CI 1.12-1.90, P = 0.005). There was no significant difference of the incidence of clinically relevant major bleeding between the two groups (n.s.). This meta-analysis indicates no effectiveness of thromboprophylaxis for preventing DVT or symptomatic VTE in patients undergoing non-major knee arthroscopy. Regarding to patient undergoing knee ligament construction, the thromboprophylactic strategy should mainly take into account the patient's risk factors.
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Affiliation(s)
- Gang Zheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China
| | - Qian Tang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China
| | - Ping Shang
- Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China
| | - Xiao-Yun Pan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China.
| | - Hai-Xiao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China.
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23
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24
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Arteriovenous Fistula after Anatomic All-Inside Anterior Cruciate Ligament Reconstruction. Case Rep Orthop 2018; 2017:1034018. [PMID: 29318071 PMCID: PMC5727692 DOI: 10.1155/2017/1034018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022] Open
Abstract
We present the first case of an arteriovenous fistula after an all-inside anterior cruciate ligament (ACL) reconstruction. A seventeen-year-old boy had an uneventful ACL reconstruction. Four weeks after surgery, the patient was seen with a pulsating swelling at the lateral distal upper leg. Vascular consultation led to the diagnosis of pseudoaneurysm and arteriovenous fistula of the lateral superior genicular artery. Most likely, fistula is caused by the stab incision for preparation of the femoral tunnel, and no anatomical cause was found. The clinical presentation, previous cases of arteriovenous fistula after arthroscopic ACL reconstruction, possible causes, and management are discussed.
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Keller RA, Moutzouros V, Dines JS, Bush-Joseph CA, Limpisvasti O. Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice? Sports Health 2017; 10:156-159. [PMID: 28927346 PMCID: PMC5857726 DOI: 10.1177/1941738117730576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States. Hypothesis: Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery. Study Design: Survey. Methods: Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis. Results: Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation. Conclusion: Half of all sports medicine fellowship–trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol. Clinical Relevance: This survey study evaluating the use of VTE prophylaxis with ACL reconstruction lends clinical insight to the current practice of a large, geographically diverse group of fellowship-trained sports medicine orthopaedic surgeons in the United States.
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