Abstract
PurposeThe 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.MethodsQuestionnaires 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.Results115 (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.ConclusionSwedish 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 evidenceIV.
Highlights
The value of the use of thromboprophylaxis following anterior cruciate ligament (ACL) reconstruction is poorly documented
According to American guidelines, thromboprophylaxis is not recommended in arthroscopic surgery, unless the patient has a history of venous thromboembolism (VTE) [1]
The aim of this study was to evaluate the ACL surgeons’ individual strategies of thromboprophylaxis and if they correspond to existing knowledge regarding the risk factors of VTE
Summary
The value of the use of thromboprophylaxis following anterior cruciate ligament (ACL) reconstruction is poorly documented. According to American guidelines, thromboprophylaxis is not recommended in arthroscopic surgery, unless the patient has a history of venous thromboembolism (VTE) [1]. In Sweden, there are no specific guidelines on when to use thromboprophylaxis in ACL reconstruction, leaving the ACL surgeon without guidance. The negative consequences of a deep vein thrombosis (DVT) are well known and include post-thrombotic syndrome, pulmonary embolism and in worst cases cardiac arrest and death. The use of thromboprophylaxis is not without risk and its negative side effects must be taken into account. Bleeding adverse events following below-knee surgery is reported with a statistically significant OR of 2.79 comparing a group receiving thromboprophylaxis with a group with no prophylaxis [2]
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