Mittal Mehul M, Chandra Krishna, Bollepalli Harshavardhan, Acevedo Katalina V, Hosseinzadeh Pooya
Department of Orthopaedics, University of Texas Southwestern Medical Center, Dallas.
Department of Orthopaedics, Baylor College of Medicine, Houston, TX.
J Pediatr Orthop. 2025 Sep 1;45(8):e680-e686. doi: 10.1097/BPO.0000000000002986. Epub 2025 Apr 17.
Arthroscopic knee procedures such as meniscus and ACL repairs are cornerstone interventions in pediatric and sports orthopaedics. While venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare yet devastating complication in major joint surgeries, its association with minimally invasive procedures remains relatively unexplored. Emerging evidence shows rates of VTE in adolescent orthopaedic patients approaching that of adults, highlighting the need to further characterize the unique risk profile of this population. Therefore, this study aims to compare VTE rates, risk factors, and chemoprophylaxis use in adolescents versus adults undergoing arthroscopic knee procedures.
A retrospective cohort study using the TriNetX Research Network identified 301,585 patients who underwent knee arthroscopy from January 2003 to January 2023, including 29,984 adolescents (aged 14 to 17) and 271,601 adults (aged 18 years or older). Propensity score matching based on sex and relevant comorbidities, including diabetes mellitus, tobacco use, oral contraceptive (OCP) use, and obesity yielded balanced cohorts of 29,984 each. Univariate logistic regression analysis was performed for preliminary assessment of the risk factors associated with VTE. P <0.01 was considered significant.
Adults had a higher 90-day incidence of DVT (1.3% vs. 0.8%) and PE (0.3% vs. 0.2%) than adolescents. Combined DVT/PE incidence was 1.5% in adults and 0.8% in adolescents (RR: 1.782). Univariate analysis showed OCP use (OR: 3.167), obesity (OR: 3.445), tobacco use (OR: 23.975), and diabetes (OR: 34.064) were significant VTE risk factors in adolescents; sex was not. Adults more frequently received postoperative chemoprophylaxis (24% vs. 20%, P <0.001), with aspirin being the most common agent (23% in adults vs. 19% in adolescents, P <0.001).
Adolescents undergoing knee arthroscopy have a lower risk of VTE compared with adults, with an incidence below 1%. Routine VTE prophylaxis may not be necessary for all adolescents but should be considered for those with significant risk factors, including diabetes, tobacco use, and obesity. Further research is warranted to refine prophylaxis guidelines in this population.
Level III-retrospective cohort study.
关节镜下膝关节手术，如半月板和前交叉韧带修复术，是小儿和运动骨科的基础干预措施。静脉血栓栓塞症（VTE），包括肺栓塞（PE）和深静脉血栓形成（DVT），是大关节手术中一种罕见但具有毁灭性的并发症，其与微创手术的关联仍相对未被充分探索。新出现的证据表明，青少年骨科患者的VTE发生率接近成年人，这凸显了进一步明确该人群独特风险特征的必要性。因此，本研究旨在比较接受关节镜下膝关节手术的青少年与成年人的VTE发生率、风险因素和化学预防措施的使用情况。
一项使用TriNetX研究网络的回顾性队列研究，确定了2003年1月至2023年1月期间接受膝关节镜检查的301,585例患者，其中包括29,984名青少年（14至17岁）和271,601名成年人（18岁及以上）。基于性别和相关合并症（包括糖尿病、吸烟、口服避孕药（OCP）使用和肥胖）进行倾向评分匹配，得到每组各29,984例的平衡队列。进行单因素逻辑回归分析以初步评估与VTE相关的风险因素。P<0.01被认为具有统计学意义。
成年人90天内DVT（1.3%对0.8%）和PE（0.3%对0.2%）的发生率高于青少年。成年人DVT/PE合并发生率为1.5%，青少年为0.8%（相对风险：1.7）。单因素分析显示，在青少年中，使用OCP（比值比：3.167）、肥胖（比值比：3.445）、吸烟（比值比：23.975）和糖尿病（比值比：34.064）是显著的VTE风险因素；性别不是。成年人术后更频繁地接受化学预防（24%对20%，P<0.001），阿司匹林是最常用的药物（成年人中为23%，青少年中为1%，P<0.001）。
与成年人相比，接受膝关节镜检查的青少年发生VTE的风险较低，发生率低于1%。并非所有青少年都需要常规的VTE预防，但对于有显著风险因素的青少年，包括糖尿病、吸烟和肥胖患者，应考虑进行预防。有必要进一步研究以完善该人群的预防指南。
III级——回顾性队列研究。
