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Open access

Andrei-Constantin Ioanovici, Andrei-Marian Feier, Ioan Țilea and Daniela Dobru

Abstract

Colorectal cancer is an important health issue, both in terms of the number of people affected and the associated costs. Colonoscopy is an important screening method that has a positive impact on the survival of patients with colorectal cancer. The association of colonoscopy with computer-aided diagnostic tools is currently under researchers’ focus, as various methods have already been proposed and show great potential for a better management of this disease. We performed a review of the literature and present a series of aspects, such as the basics of machine learning algorithms, different computational models as well as their benchmarks expressed through measurements such as positive prediction value and accuracy of detection, and the classification of colorectal polyps. Introducing computer-aided diagnostic tools can help clinicians obtain results with a high degree of confidence when performing colonoscopies. The growing field of machine learning in medicine will have a big impact on patient management in the future.

Open access

Octav Marius Russu, Andrei Marian Feier, Tudor Sorin Pop, Marcela Todoran and István Gergely

Abstract

Objective: To determine the influence of a new intraarticular hyaluronic acid based hydrogel (Hymovis®) injections on the amount of analgesics consumption in patients diagnosed with primary knee OA.

Methods: A prospective, single-center study that included 35 patients, aged 45-80 years was conducted in our orthopaedics department. Patients received two intra-articular injections of hyaluronic acid (24 mg/3 ml; 500–730 kDa; Hymovis®) at one week apart. Follow-up was scheduled at 2 and 6 months after the injections. Assessment tools included Visual Analogue Scale (VAS) and an in-house designed questionnaire regarding analgesic consumption (quantity, period and product) during the follow-up.

Results: Compared to baseline, a significant amelioration in visual analogue scale was observed at six months’ follow-up (74.2mm ± 11.7 vs. 57.3mm ± 12.1; p <.0001). 28% (n=10) of the patients reduced their total analgesic consumption at two months after the injections. At final follow-up, the analgesic intake was reduced by more than 50% in almost every case.

Conclusions: Intraarticular administered injections with a novel hyaluronan-based hydrogel (Hymovis®) may reduce the amount of analgesic consumption and self-reported pain intensity in patients with knee OA.

Open access

Octav Marius Russu, Andrei Marian Feier, Tudor Sorin Pop, Marcela Todoran and István Gergely

Abstract

Objective: Our purpose was to assess the effect of a new hyaluronic acid-based (Hymovis®) injections on joint space width narrowing in patients diagnosed with knee osteoarthritis.

Methods: A prospective clinical trial was conducted in the Department of Orthopedics and Traumatology II from the Clinical County Hospital, Tîrgu Mureș, Romania. Thirty-five patients diagnosed with idiopathic knee osteoarthritis received two intraarticular injections with hyaluronic acid-based hydrogel (24 mg of hyaluronic acid/3 ml) at one-week interval. Anteroposterior radiographs were obtained before the injections, at six and twelve months after. Minimum joint space width was measured by two senior orthopaedics surgeons at each follow up. Each radiograph was measured again by the same evaluators two weeks apart.

Results: Thirty-one patients were present at the final follow-up. A minor reduction in mean weight was noticed (from 82.2 kg ± 16.2 kg to 80.9 kg ± 16.0, p > 0.398) without any correlation with joint space width narrowing. There were no major changes at the first follow up (6 months) regarding joint space narrowing. A reduction in joint space width was observed however at 12 months varying from 4.4 mm (SD ± 1.64, range 1.8-7.1) at the first assessment to 4.3 mm (SD ± 1.26, range 0.0-6.8) at the final follow-up but with no statistical difference (p=0.237).

Conclusion: No significant modification in joint space width at the final follow-up secondarily proved that two injections of Hymovis® may slow down narrowing in the knee joint space over a one-year period.

Open access

Octav Russu, Tiberiu Bățagă, Andrei-Marian Feier, Radu Prejbeanu, Radu Fleaca, Mihai Roman and István Gergely

Abstract

Introduction: Anterior cruciate ligament (ACL) rupture is one of the most common lesions in knee traumatology; therefore the number of ACL reconstructions is increasing worldwide. Usually, an anteromedial (AM) accessory portal is required in anatomical positioning of the femoral tunnel, which is not absolutely necessary in this technique. Aim: Assessment of all-inside ACL reconstruction preliminary clinical results with adjustable loops and buttons on both femoral and tibial surfaces. Method: Our prospective study included 28 subjects (19 male, 9 female) with chronic ACL ruptures. The mean age of the study population was 27.72 ± 8.23 years. In all cases ACL reconstruction was carried out with the use of quadrupled semitendinosus auto-grafts with adjustable loops and buttons on the femoral and tibial surfaces and anatomic placement of both tunnels, using an outside-in technique, with flipcutters (Arthrex®). Clinical and radiological evaluations were carried out before surgery and at 3 and 6 months postoperatively, with the Lysholm scoring system, the Tegner activity scale and anterior-posterior and latero-lateral X-rays. Anterior knee laxity was measured in 25° of flexion using a portable arthrometer (RolimeterTM, Aircast®) and maximum manual force. Results: During the final follow-up, the Lysholm score was good and excellent in 27 cases, with a mean Lysholm score of 95.55 ± 4.63; all results were classified as good. The mean preoperative Tegner activity score was 3.46 ± 1.71 (range: 1-7), and the post-operative mean score was 5.75 ± 2.24 (range: 2-10). We found no graft ruptures. Preoperative knee laxity measurements showed a mean displacement of 11.5 ± 3.1 mm and side-to-side differences of 5.6 ± 3.5 mm, while the postoperative measurements at the last follow-up were 6.3 ± 1.54 mm and 2.65 ± 1.86 mm, respectively. Conclusion: Short-term clinical outcomes of all-inside ACL restoration with anatomic placement femoral and tibial tunnels seem to recommend this surgical option, with good subjective and objective results. Additional research will have to prove the long-term success.

Open access

István Gergely, Tudor Sorin Pop, Tiberiu Bățagă, Andrei-Marian Feier, Sándor-György Zuh and Octav Russu

Abstract

Knee osteoarthritis or gonarthrosis is considered the most common joint disease, affecting more than 70% of subjects aged over 65 years. Its occurrence is increasing with age and is more problematic with the current rise in the incidence of obesity. In severe and advanced cases, total knee arthroplasty is recommended as a gold standard therapy for pain relief, restoration of normal knee function, and quality of life improvement. There are numerous controversies whether total knee arthroplasty is able to reach and provide end-point outcomes and restore previous function of the knee joint. Studies suggest that the surgeons’ experience, type of prosthesis used, associated pathology, underlying pathologies, risk factors, continuous passive movement, and patient expectations about the surgery may influence the outcomes to a great extent. “Normal knee function” is a statement that is hardly defined in the current literature, as authors usually refer to subjective results when analyzing outcomes. Objective results may be more straightforward, but they do not always symbolize the actual state that the patient is reporting or the actual quality of life. Our objective was to analyze and present summaries of the current literature regarding normal knee function restoration after total knee replacement surgery. Our literature review results confirm the hypothesis that subjective and objective results are difficult to interpret and unravel. Complex future trials may bring supplementary and clearer conclusions regarding knee function and kinematics, clinical improvement, patient satisfaction, and quality of life.

Open access

Radu Fleaca, Mihai Roman, Tiberiu Bățagă, Andrei-Marian Feier, Radu Prejbeanu, Vlad Predescu, Sándor-György Zuh, István Gergely and Octav Russu

Abstract

Anterior cruciate ligament (ACL) injuries are increasing amongst professional and recreational athletes, and creating prevention programs to reduce the occurrence of ACL damages is becoming a necessity. To prevent an ACL tear, it is necessary to comprehend the mechanisms and the risk factors of injury. Biomechanical and clinical studies try to understand these complex mechanisms in order to identify factors that can be improved and to develop training programs to prevent at least non-contact ACL injuries. There are several promising programs, but there are still many questions to answer. This paper analyzes the risk factors for ACL injuries and some aspects of the modern programs developed to decrease the rate of ACL tears.

Open access

Octav Russu, Tiberiu Bățagă, Marcela Todoran, Emilian Ciorcila, Teodora Maria Denisa Popa, Andrei-Marian Feier, Radu Prejbeanu, Radu Fleaca, Mihai Roman, Tudor Sorin Pop and István Gergely

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure and considered to be the gold standard in restoring knee function and stability in ACL-deficient knees. The TransLateral all-inside technique implies the use of only two portals – anterolateral and anteromedial, without the use of an accessory portal. The work is done using the lateral portal, while the medial portal serves as a viewing site. Only a few studies have been published regarding the assessment of the functional and clinical outcomes of this novel technique.

Aim of the study: To determine the clinical effectiveness of the TransLateral procedure used for ACL reconstruction and its ability to re-establish joint functionality and stability in ACL-deficient knees.

Material and methods: A prospective study was conducted at the Orthopedics and Traumatology Clinic no. 2 in Tîrgu Mureș. Thirty-two patients matched our inclusion criteria and were operated using the TransLateral technique for ACL reconstruction. Outcome assessment was performed using the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner Activity Scale. The questionnaires include items referring to pain, physical functioning, sports activities, and quality of life. Operative time and ACL graft size were also documented.

Results: All patients underwent single-bundle ACL restoration using a quadrupled semitendinosus tendon. Out of 32 patients, 21 had associated meniscus lesions and 8 collateral ligament injuries. Mean graft diameter was 8.7 mm and mean length 63.2 mm. Significantly improved KOOS values were found at 12 months post-surgery regarding the mean baseline score: 59.3 ± 5.3 vs. 95.3 ± 4.9, p <0.0001. The Lysholm score improved from a mean of 56.3 ± 4.9 to 93.9 ± 5.6, p <0.0001 at the end-point. The Tegner activity scale ranged from 3.8 ± 1.9 to 5.9 ± 2.4, p <0.0001 at the final follow-up.

Conclusions: The TransLateral technique proved its clinical effectiveness and its ability to restore knee stability after ACL reconstruction surgery.

Open access

Radu Fleaca, Radu Prejbeanu, Andrei-Marian Feier, Octav Russu, Adrian Todor, Vlad Predescu, Bogdan Codorean, Tiberiu Bățagă and Mihai Roman

Abstract

The treatment for anterior cruciate ligament (ACL) deficient knee consists in its surgical reconstruction. There are several available and validated techniques, but there are still numerous questions to be answered concerning the best approach in terms of stability, functional outcome, and avoiding further damage in the knee. This paper sought to analyze the studies published in the literature comparing the outcomes of ACL restoration with single-bundle versus double-bundle techniques. The results demonstrate that even if biomechanical studies find an increased steadiness with double-bundle ACL reconstruction, there seems to be no clinical or functional benefit compared with single-bundle reconstruction.

Open access

Mihai Roman, Radu Prejbeanu, Andrei-Marian Feier, Octav Russu, Adrian Todor, Vlad Predescu, Bogdan Codorean, Tiberiu Bățagă and Radu Fleaca

Abstract

Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL) requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores) of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.