Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 30; no. 11; pp. 3634 - 3643
• Main Authors: Easwaran, Raju, Khan, Moin, Sancheti, Parag, Shyam, Ashok, Bhandari, Mohit, Ranawat, Anil S., Thakkar, Savyasachi, Parikh, Shital, Musahl, Volker, Joglekar, Siddharth, J.Deshmukh, Ajit, Plancher, Kevin, Verma, Nikhil, McAllister, David, Verdonk, Peter, Lustig, Sebastien, Chandrateya, Amit, Smigleiski, Robert, Solayar, Gandhi, Chernchujit, Bancha, Yung, Patrick, Budhiparama, Nicolaas, Hoshino, Yuichi, White, Nathan, Parker, David, Clatworthy, Mark, Brown, Charlie, Manzary, Mojieb, Rajan, David, Narvekar, Abhay, Tapasvi, Sachin, Pardiwala, Dinshaw, Panigrahi, Ranjit, Arumugam, S., Kapoor, Vikash, Mody, Bharat, Maheshwari, Jitender, Dahiya, Vivek, Joseph, Clement, Laddha, Mukesh, Rajgopal, Ashok
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2022; Springer Nature B.V; Springer Verlag
• Subjects: Arthroscopy; Biomechanics; Case reports; Contraceptives; Disease prevention; Embolism; Engineering Sciences; Genetics; Guidelines; Knee; Mechanics; Medicine; Medicine & Public Health; Oral contraceptives; Orthopedics; Patients; Prophylaxis; Questionnaires; Soft tissues; Sports Medicine; Surgery; Thromboembolism; Trauma; Deep venous thrombosis; VTE prophylaxis; Modified Delphi; Venous thromboembolism; Knee soft tissue reconstruction; Knee arthroscopy; KNEE JOINT; VENOUS THROMBOEMBOLISM; DEEP VENOUS THROMBOSIS; KNEE SOFT TISSUE RECONSTRUCTION; HUMANS; ARTHROSCOPY; VTE PROPHYLAXIS; KNEE ARTHROSCOPY; MODIFIED DELPHI; CONTRACEPTIVES, ORAL; FEMALE
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-022-06973-w

Purpose
There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic.
Methods
The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus.
Results
Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis.
Conclusion
It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc.
Level of evidence
Level V.