Prophylaxis Does Not Prevent Symptomatic Venous Thromboembolism Following Anterior Cruciate Ligament Surgery: A Systematic Review and Meta-Analysis.

Abstract

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potential complication following anterior cruciate ligament reconstruction (ACLR). The necessity and efficacy of routine thromboprophylaxis following ACL reconstruction remain controversial. To determine the efficacy and safety of thromboprophylaxis, in preventing symptomatic venous thromboembolism (VTE) following ACLR. A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. Electronic searches of MEDLINE, EMBASE, PubMed, and Cochrane Library were performed from inception to January 2026. Included studies compared any form of VTE prophylaxis (pharmacologic, mechanical, or combination approaches) to a control group (no prophylaxis) in patients undergoing isolated ACLR, reporting on symptomatic VTE as a primary outcome. Symptomatic VTE events were pooled and compared using a random-effects model, calculating the pooled odds ratio (OR) with 95% confidence intervals (CI). Thirteen studies, comprising 29,186 patients, were included (1 RCT, 12 observational studies). The mean age of the overall patient cohort ranged from 26.5 to 34.2 years, with predominantly male patients (approximately 59.3%). The pooled incidence of symptomatic VTE across all studies was 0.41% (120/29,186 patients). Comparative analysis showed 51 symptomatic events in the prophylaxis group (n=10,984, 0.46%), and 69 events in the no prophylaxis group (n=18,202, 0.38%). Meta-analysis of eligible studies showed no statistically significant impact of thromboprophylaxis on the risk of symptomatic VTE occurrence (risk difference [RD], 0.00; 95% CI, -0.00 to 0.00; p = 0.795). The overall complication rate was notably higher among those who received prophylaxis (n=122, 1.11%) compared to those who did not (n=6, 0.03%), primarily due to minor bleeding events and hemarthrosis. Routine thromboprophylaxis following isolated ACLR does not yield a statistically significant reduction in the incidence of symptomatic VTE in the general patient population, which already has a very low intrinsic risk (0.41%). Given the very low baseline risk and potential for complications, routine prophylaxis is not recommended for all patients undergoing isolated ACLR. A risk-stratified approach using validated assessment tools should be employed to identify high-risk individuals who may benefit from prophylaxis. III.