JSES - 2026-06-24 - Journal Article
Incidence of Lower Extremity Deep Vein Thrombosis Following Arthroscopic Rotator Cuff Repair.
Akimoto K, Ikeda Y, Nakajima F, Hashimoto M, Abe Y, Takuro M, Kanno K, Shimizu K, Ochiai N, Hashimoto E, Ohtori S
Topics
Key Takeaway
Lower extremity DVT occurred in 5.3% of patients after arthroscopic rotator cuff repair, all asymptomatic and distal, with age ≥65 years (OR 8.7) and female sex (OR 6.0) as independent risk factors.
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Summary
This prospective study screened 209 patients undergoing ARCR with serial lower extremity ultrasonography on PODs 3, 7, and 10 to determine DVT incidence and identify risk factors. DVT was detected in 11 patients (5.3%), all asymptomatic peripheral/distal thrombi; D-dimer >3.9 μg/mL on POD 7 yielded AUC 0.82 for DVT prediction. Multivariate logistic regression identified age ≥65 years (OR 8.7) and female sex (OR 6.0) as independent risk factors.
Key Limitation
Screening terminated at POD 10 with no follow-up ultrasonography, leaving the natural history of detected distal DVTs—including proximal propagation and PE risk—completely uncharacterized.
Original Abstract
PURPOSE
Lower extremity deep vein thrombosis (DVT) is one of the primary causes of pulmonary embolism, a serious postoperative complication of orthopedic surgery. The true incidence of venous thromboembolism, including asymptomatic DVT, after arthroscopic rotator cuff repair (ARCR) remains unclear. This prospective study aimed to investigate the incidence of lower extremity DVT after ARCR, evaluate perioperative D-dimer changes, and identify DVT risk factors.
METHODS
Patients undergoing ARCR without preoperative DVT were enrolled in this study. The incidence and location of lower extremity DVT, perioperative changes in D-dimer levels, and patient characteristics (background, comorbidity, past medical history, operative data) were evaluated. Lower extremity ultrasonography was performed to screen for DVT on postoperative days (PODs) 3, 7, and 10. D-dimer levels were measured on the same days, and the cutoff values for predicting DVT were determined. Multivariate logistic regression analysis was conducted to identify independent risk factors for DVT after ARCR.
RESULTS
A total of 209 patients (mean age 65.4 years) were enrolled. On POD 3, 7 and 10, peripheral DVT was detected in 11 patients, who remained asymptomatic. The D-dimer levels were significantly higher in the respective patients with DVT than patients without DVT on each postoperative day (POD 3: 2.6 vs. 1.6 μg/mL; POD 7: 4.7 vs. 2.6 μg/mL; POD 10: 4.4 vs. 3.0 μg/mL; P = 0.01, < 0.001 and 0.01). The D-dimer cutoff values for DVT were 1.4 μg/mL on POD 3, 3.9 μg/mL on PODs 7 and 10 (area under the curve: 0.72, 0.82 and 0.74). Multivariate logistic regression analysis found that age ≥65 years and female sex were independent risk factors for DVT following ARCR (Odds ratio: 8.7 and 6.0; 95% confidence intervals; 1.1 - 70.0 and 1.3 - 28.9; P = 0.04 and 0.03).
CONCLUSIONS
The incidence of lower extremity DVT after ARCR was 5.3%. A D-dimer level >3.9 μg/mL on POD 7 had high diagnostic accuracy. Age ≥65 years and female sex were risk factors for lower extremity DVT after ARCR. However, given that all detected cases were asymptomatic and limited to distal veins, routine screening for lower extremity DVT after ARCR may not be necessary.
LEVEL OF EVIDENCE
Level I, Prospective Cohort Design, Prognosis Study.