Original article
Deep Venous Thrombosis After Knee Arthroscopy: A Meta-analysis

https://doi.org/10.1016/j.arthro.2005.03.007Get rights and content

Purpose: To better establish the incidence of deep venous thrombosis (DVT) after knee arthroscopy without prophylaxis. Type of Study: Meta-analysis. Methods: A MEDLINE search was performed to find published English-language studies of DVT following knee arthroscopy. Strict inclusion criteria required any investigation included for analysis to (1) be prospective, (2) include a population not given any antithrombotic prophylaxis, (3) perform universal screening of the lower extremity venous system using either ultrasound or venography, and (4) include a discrete population limited to unilateral arthroscopic knee surgery, exclusive of ligament surgery or open procedures. The results of the venographic studies were given additional weight mathematically to account for the increased sensitivity of this imaging modality compared with ultrasound in detecting DVT in asymptomatic lower extremities. Results: The unprophylaxed patient populations in the 6 studies that met inclusion criteria ranged from 64 to 184 patients, and totaled 684. The total incidence rate of DVT in each study ranged from 3.1% to 17.9%, whereas the incidence rate of proximal DVT ranged from none detected to 4.9%. The total DVT rate was not related to the method of DVT detection, whereas proximal DVT was only noted in the 2 studies using contrast venography. Combining the 6 studies yields a total DVT incidence of 9.9% (95% confidence interval, 8.1%-11.7%), and a proximal DVT incidence of 2.1% (95% confidence interval, 1.2%–3.0%). Conclusions: DVT following knee arthroscopy is a consistent finding in studies of unprophylaxed patients when routine screening using ultrasound or contrast venography is used. Current data suggest an overall DVT rate of 9.9% and a proximal DVT rate of 2.1% after knee arthroscopy without antithrombosis prophylaxis. Level of Evidence: Level II, Systematic Review of Levels I and II Diagnostic Studies.

Section snippets

Methods

A MEDLINE search was performed to find published English-language studies of DVT following knee arthroscopy from 1966 to December 2004. Combinations of the medical subject headings—DVT, thromboembolism, knee, arthroscopy, incidence, surgery, and venous thrombosis—were used to identify all articles that evaluated the incidence of DVT after knee arthroscopy. Bibliographies of retrieved articles were checked for any additional studies. Strict inclusion criteria required any investigation included

Results

The unprophylaxed patient populations in the 6 studies that met inclusion criteria ranged from 64 to 184, and totaled 684 patients. Two studies screened with ascending contrast venography, and 4 studies used ultrasonography. For 3 investigations, including the 2 that used venography, the entire population underwent knee arthroscopy without prophylaxis.6, 9, 10 Two of the remaining 3 studies included a discrete patient group given low-molecular-weight heparin as prophylaxis11, 12 and the third

Discussion

Before valid recommendations can be made regarding DVT prophylaxis after knee arthroscopy, it is imperative to establish a reliable estimate of the incidence of this complication. Several prospective studies have attempted this, but each contains a small number of subjects relative to similar studies looking at thromboembolic events following total hip or total knee arthroplasty. Given the current lack of large studies, a meta-analysis combining several studies using strict inclusion criteria

Conclusions

DVT following knee arthroscopy is a consistent finding in studies of unprophylaxed patients when routine screening using ultrasound or contrast venography is used. This meta-analysis of the current literature suggests an overall DVT rate of 9.9% and a proximal DVT rate of 2.1% following knee arthroscopy without antithrombosis prophylaxis.

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    These are usually considered low-to-moderate thromboembolic risk [88]. A meta-analysis of studies in which no pharmacological thromboprophylaxis was provided to patients undergoing knee arthroscopy reported an overall DVT rate (incidental and symptomatic) of almost 10% by ultrasound or venography, and a 2% rate of proximal DVT [89]. Given the additional risks associated with elite athletes, this rate may be further enhanced in this population.

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