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Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy

Murphy, Robert F., MD; Heyworth, Benton, MD; Kramer, Dennis, MD; Naqvi, Manahil, BS; Miller, Patricia E., MS; Yen, Yi-Meng, MD, PhD; Kocher, Mininder S., MD, MPH; Shore, Benjamin J., MD, MPH, FRCSC

Journal of Pediatric Orthopaedics: March 2019 - Volume 39 - Issue 3 - p 125–129
doi: 10.1097/BPO.0000000000000894
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Background: The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population.

Methods: Medical records were reviewed in all pediatric and adolescent patients (≤19 y) who underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE in the postoperative period. Demographic features were recorded, and included age, sex, body mass index, clinical characteristics (diagnosis, type of surgical intervention, tourniquet time), VTE risk factors [family history of VTE, obesity (body mass index >30), oral contraceptive use, and smoking use/exposure] and treatment (anticoagulation type/duration).

Results: Out of 2783 patients who underwent knee arthroscopy during the 5-year study period, 7 patients (3 males, 4 females, mean age, 16.9 y, range, 15 to 18) developed a symptomatic postoperative VTE (incidence, 0.25%, 95% confidence interval, 0.11%-0.54%). There were 6 unilateral deep venous thrombosis, and 1 bilateral deep venous thrombosis. Arthroscopic procedures performed in this cohort included anterior cruciate ligament reconstruction (3), isolated lateral release (1), meniscectomy (2), and patellar realignment with arthroscopic lateral release, open tibial tubercle osteotomy, and open proximal medial retinacular reefing (1). VTE was diagnosed an average of 9 days following surgery (range, 3 to 16). All patients were initially treated with low–molecular-weight heparin, and 2 were converted to warfarin. Mean duration of anticoagulation treatment was 64 days (range, 28 to 183). All patients had at least 1 identifiable medical or surgical risk factor, including oral contraceptive use (2), smoking (2), obesity (2), an arthroscopically assisted open procedure (4), or tourniquet time >60 minutes (3).

Conclusions: VTE after adolescent knee arthroscopy has not been well described. The incidence is ∼0.25%. Previously established risk factors for VTE were present in 100% of the affected population. Low–molecular-weight heparin was used to successfully treat this complication.

Level of Evidence: Level IV.

Medical University of South Carolina, Charleston, SC and Boston Children’s Hospital, Boston, MA

The authors declare no conflicts of interest.

Reprints: Robert F. Murphy, MD, Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425. E-mail: murphy.r.f@gmail.com.

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