Deep Venous Thrombosis After Knee Arthroscopy: A Systematic Review and Meta-Analysis


      To establish a contemporary literature-based estimate of the incidence of deep venous thrombosis (DVT) after knee arthroscopic surgery.


      We performed a systematic review and meta-analysis of the English language literature to assess the efficacy of prophylaxis to prevent DVT after knee arthroscopic surgery. Only randomized controlled trials (RCTs) or prospective studies were considered. Studies were excluded if they were not original prospective studies concerning DVT detected by imaging after knee arthroscopic surgery. We calculated pooled proportions of postoperative DVT and proximal DVT.


      Nine prospective uncontrolled studies and 4 RCTs were retrieved. Within them, the populations given low-molecular-weight heparin (LMWH) to prevent DVT had a 0.1% to 11.9% incidence of DVT, with an overall 36 DVTs identified (4 proximal), averaging 1.8%. One hundred thirty-six DVTs (29 proximal) were indicated in the populations without prophylaxis, and the DVT incidence varied from 1.8% to 41.2%, averaging 6.8%. Of the RCTs, the pooled risk ratio for DVT to develop was 0.180 (range, 0.065 to 0.499) for those who had LMWH as prophylaxis. An absolute risk reduction of 1.2%—from 1.5% to 0.3%—for the development of proximal DVT was observed.


      Compared with patients who did not receive prophylaxis, the pooled risk ratio for the development of DVT was 0.18 for those who had LMWH prophylaxis. The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis (4 of 2,184) or not (29 of 1,814). The rate of proximal DVT in total DVT occurrence can be markedly reduced from 21.3% (29 of 136) to 11.1% (4 of 36).

      Level of Evidence

      Level IV. This study is a meta-analysis of RCTs and a systematic review of Level IV studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Westrich G.H.
        • Allen M.L.
        • Tarantino S.J.
        • et al.
        Ultrasound screening for deep venous thrombosis after total knee arthroplasty. 2-year reassessment.
        Clin Orthop Relat Res. 1998:Nov; : 125-133
        • Tomkowski W.Z.
        • Davidson B.L.
        • Wisniewska J.
        • et al.
        Accuracy of compression ultrasound in screening for deep venous thrombosis in acutely ill medical patients.
        Thromb Haemost. 2007; 97: 191-194
        • Schellong S.M.
        • Beyer J.
        • Kakkar A.K.
        • et al.
        Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery:the VENUS study.
        J Thromb Haemost. 2007; 5: 1431-1437
        • Wille-Jorgensen P.
        • Jorgensen L.N.
        • Crawford M.
        Asymptomatic postoperative deep vein thrombosis and the development of postthrombotic syndrome. A systematic review and meta-analysis.
        Thromb Haemost. 2005; 93: 236-241
        • Schindler O.S.
        • Dalziel R.
        Post-thrombotic syndrome after total hip or knee arthroplasty: Incidence in patients with asymptomatic deep venous thrombosis.
        J Orthop Surg (Hong Kong). 2005; 13: 113-119
        • Persson L.M.
        • Lapidus L.J.
        • Larfars G.
        • Rosfors S.
        Asymptomatic deep venous thrombosis is associated with a low risk of post-thrombotic syndrome.
        Eur J Vasc Endovasc Surg. 2009; 38: 229-233
        • Kahn S.R.
        • Shbaklo H.
        • Lamping D.L.
        • et al.
        Determinants of health-related quality of life during the 2 years following deep vein thrombosis.
        J Thromb Haemost. 2008; 6: 1105-1112
        • Michot M.
        • Conen D.
        • Holtz D.
        • et al.
        Prevention of deep vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low-molecular weight heparin.
        Arthroscopy. 2002; 18: 257-263
        • Marlovits S.
        • Striessnig G.
        • Schuster R.
        • et al.
        Extended duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: A prospective, randomized, placebo-controlled study.
        Arthroscopy. 2007; 23: 696-702
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Mantel N.
        • Haenszel W.
        Statistical aspects of the analysis of data from retrospective studies of disease.
        J Natl Cancer Inst. 1959; 22: 719-748
        • Higgins J.P.T.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Otero-Fernandez R.
        • Gomez-Outes A.
        • Martinez-Gonzalez J.
        • Rocha E.
        • Fontcuberta J.
        Evaluation of the effectiveness and safety of bemiparin in a large population of orthopaedic patients in a normal clinical practice.
        Clin Appl Thromb Hemost. 2008; 14: 75-83
        • Schippinger G.
        • Wirnsberger G.H.
        • Obernosterer A.
        • Babinski K.
        Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients.
        Acta Orthop Scand. 1998; 69: 144-146
        • Adala R.
        • Anand A.
        • Kodikal G.
        Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction.
        Indian J Orthop. 2011; 45: 450-453
        • Demers C.
        • Marcoux S.
        • Ginsberg J.S.
        • Laroche F.
        • Cloutier R.
        • Poulin J.
        Incidence of venographically proved deep vein thrombosis after knee arthroscopy.
        Arch Intern Med. 1998; 158: 47-50
        • Ettema H.B.
        • Hoppener M.R.
        • Veeger N.J.
        • Buller H.R.
        • Van der Meer J.
        Low incidence of venographically detected deep vein thrombosis after knee arthroscopy without thromboprophylaxis: A prospective cohort study.
        J Thromb Haemost. 2006; 4: 1411-1413
        • Hoppener M.R.
        • Ettema H.B.
        • Henny C.P.
        • Verheyen C.C.
        • Buller H.R.
        Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: A prospective cohort study of 335 patients.
        Acta Orthop. 2006; 77: 767-771
        • Stringer M.D.
        • Steadman C.A.
        • Hedges A.R.
        • Thomas E.M.
        • Morley T.R.
        • Kakkar V.V.
        Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients.
        J Bone Joint Surg Br. 1989; 71: 492-497
        • Williams Jr., J.S.
        • Hulstyn M.J.
        • Fadale P.D.
        • et al.
        Incidence of deep vein thrombosis after arthroscopic knee surgery: A prospective study.
        Arthroscopy. 1995; 11: 701-705
        • Cullison T.R.
        • Muldoon M.P.
        • Gorman J.D.
        • Goff W.B.
        The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction.
        Arthroscopy. 1996; 12: 657-659
        • Camporese G.
        • Bernardi E.
        • Prandoni P.
        • et al.
        Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: A randomized trial.
        Ann Intern Med. 2008; 149: 73-82
        • Wirth T.
        • Schneider B.
        • Misselwitz F.
        • et al.
        Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): Results of a randomized controlled trial.
        Arthroscopy. 2001; 17: 393-399
        • Ilahi O.A.
        • Reddy J.
        • Ahmad I.
        Deep venous thrombosis after knee arthroscopy:a meta-analysis.
        Arthroscopy. 2005; 21: 727-730
        • Fowkes F.J.
        • Price J.F.
        • Fowkes F.G.
        Incidence of diagnosed deep vein thrombosis in the general population: Systematic review.
        Eur J Vasc Endovasc Surg. 2003; 25: 1-5
        • Tagalakis V.
        • Patenaude V.
        • Kahn S.R.
        • Suissa S.
        Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort.
        Am J Med. 2013; 126: 832.e13-832.e21
        • Naess I.A.
        • Christiansen S.C.
        • Romundstad P.
        • Cannegieter S.C.
        • Rosendaal F.R.
        • Hammerstrøm J.
        Incidence and mortality of venous thrombosis: A population-based study.
        J Thromb Haemost. 2007; 5: 692-699
        • Müller-Bühl U.
        • Leutgeb R.
        • Engeser P.
        • Achankeng E.N.
        • Szecsenyi J.
        • Laux G.
        Varicose veins are a risk factor for deep venous thrombosis in general practice patients.
        Vasa. 2012; 41: 360-365
        • Liew N.C.
        • Chang Y.H.
        • Choi G.
        • et al.
        Asian venous thromboembolism guidelines: Prevention of venous thromboembolism.
        Int Angiol. 2012; 31: 501-516
        • Greene J.W.
        • Deshmukh A.J.
        • Cushner F.D.
        Thromboembolic complications in arthroscopic surgery.
        Sports Med Arthrosc. 2013; 21: 69-74
        • Pellegrini Jr., V.D.
        • Langhans M.J.
        • Totterman S.
        • Marder V.J.
        • Francis C.W.
        Embolic complications of calf thrombosis following total hip arthroplasty.
        J Arthroplasty. 1993; 8: 449-457
        • Pellegrini Jr., V.D.
        • Clement D.
        • Lush-Ehmann C.
        • Keller G.S.
        • Evarts C.M.
        Natural history of thromboembolic disease after total hip arthroplasty.
        Clin Orthop Relat Res. 1996; 333: 27-40
        • Kim Y.H.
        • Yoo J.H.
        • Kim J.S.
        Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty.
        J Arthroplasty. 2007; 22: 974-980
        • Neviaser A.S.
        • Chang C.
        • Lyman S.
        • Della Valle A.G.
        • Haas S.B.
        High incidence of complications from enoxaparin treatment after arthroplasty.
        Clin Orthop Relat Res. 2010; 468: 115-119
        • Jameson S.S.
        • Dowen D.
        • James P.
        • Pedraza I.S.
        • Reed M.R.
        • Deehan D.J.
        The burden of arthroscopy of the knee: A contemporary analysis of data from the English NHS.
        J Bone Joint Surg Br. 2011; 93: 1327-1333
        • Jameson S.S.
        • Dowen D.
        • James P.
        • Pedraza I.S.
        • Reed M.R.
        Complications following anterior cruciate ligament reconstruction in the English NHS.
        Knee. 2012; 19: 14-19
        • Maletis G.B.
        • Inacio M.C.S.
        • Reynolds S.
        • Funahashi T.T.
        Incidence of symptomatic venous thromboembolism after elective knee arthroscopy.
        J Bone Joint Surg Am. 2012; 94: 714-720
        • Bohensky M.A.
        • Desteiger R.
        • Kondogiannis C.
        • et al.
        Adverse outcomes associated with elective knee arthroscopy: A population-based cohort study.
        Arthroscopy. 2013; 29: 716-725
        • Irani S.
        • Conen D.
        Should postoperative thromboembolism prevention be extended to the post-hospitalization phase?.
        Schweiz Med Wochenschr. 1996; 126 (in German): 386-391

      Linked Article

      • Thromboprophylaxis in Arthroscopic Surgery
        ArthroscopyVol. 30Issue 7
        • Preview
          I read with interest the meta-analysis by Sun et al.,1 and I would like to compliment the authors for a thorough review. It shows that thromboprophylaxis is important even for ambulatory care surgeries such as knee arthroscopy, and one should be vigilant in suspecting DVT.
        • Full-Text
        • PDF