Vlad Predescu

Co-stimulatory and adhesion molecules of dendritic cells in rheumatoid arthritis

Dendritic cells (DCs) in the rheumatoid arthritis (RA) joint mediate the immunopathological process and act as a potent antigen presenting cell. We compared the expression of co‐stimulatory and adhesion molecules on DCs in RA patients versus controls with traumatic joint lesions and evalulated the correlation between the immunophenotypical presentation of DCs and the clinical status of the disease. Samples of peripheral venous blood, synovial fluid (SF) and synovial tissue (ST) were obtained from 10 patients with RA at the time of hip or knee replacement and from 9 control patients with knee arthroscopy for traumatic lesions. Clinical status was appreciated using the DAS28 score. Blood, SF and dissociated ST cell populations were separated by centrifugation and analyzed by flow cytometry. Cells phenotypes were identified using three‐color flow cytometry analysis for the following receptors HLA‐DR, CD80, CD83, CD86, CD11c, CD18, CD54, CD58, CD3, CD4, CD8, CD19, CD20, CD14, CD16, CD56. HLA‐DR molecules, co‐stimulatory receptors CD80, CD86, CD83 and adhesion molecules CD18, CD11c, CD54, CD58, were analyzed by two‐color immunofluorescence microscopy on ST serial sections. In patients with active RA (DAS28>5.1) we found a highly differentiated subpopulation of DCs in the ST and SF that expressed an activated phenotype (HLA‐DR, CD86+, CD80+, CD83+, CD11c+, CD54+, CD58+). No differences were found between circulating DCs from RA patients and control patients. Our data suggest an interrelationship between clinical outcome and the immunophenotypical presentation of DCs. Clinical active RA (DAS28>5.1) is associated with high incidence of activated DCs population in the ST and SF as demonstrated by expression of adhesion and co‐stimulatory molecules.

The role of sonication in the microbiological diagnosis of implant-associated infections – the experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest

The role of sonication in the microbiological diagnosis of implant-associated infections – the experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest Raluca Mihăilescu, Daniela Tălăpan, Olga Dorobăț, Alexandru Rafila, Emilia Capraru, Daniela Munteanu, Anca Streinu-Cercel, Oana Streinu-Cercel, Vlad Predescu, Florian Purghel, Cătălin Cârstoiu, Razvan Ene, Dana Mihaela Jianu, Cristina Popescu, Victoria Aramă, Adrian Streinu-Cercel

A new approach in the miniminvasive treatment of fractures

The use of biological cement with provisory closed percutaneous Kirschner wire (K-wire) fixation enabled the treatment of 12 patients with fractures. Within the period November 2010—February 2011, we have treated at Saint Pantelimon Emergency Orthopaedics Clinic 12 patients using this specific method, namely: 8 humeral fractures, 1 distal radial fracture, 1 distal radial fracture associated with carpal scaphoid fracture, 1 ankle fracture, and a delayed union of distal tibial fracture. In the specialized literature, the use of bone substitutes or of biological bone cement has never been described in the treatment of fractures without the opening of the fracture site. Some bone fillers for bone defects have been injected before, together with osteosynthesis means, plates and screws, respectively. The assessment of the results has to take into account the consolidation range of each type of fracture, and the cast fixation must be extended accordingly. The recovery shall depend upon the fracture’s callus biology, the fracture’s type and location as well as the age of the patient. We evaluate the results after clinical and radiological criteria. Consolidation was achieved in all cases. We will present also the complications related to first use of this new method. The use of Kryptonite-X injected under fluoroscopic control in the conservative treatment of the fractures is a novelty. Thus, it is introduced the perspective of an innovative way of treating the fractures. Consolidation was achieved in all cases.

Surgical Approaches for Total Knee Arthroplasty

Total knee arthroplasty surgery is a current practice in orthopedic surgery. The success of this intervention consists in part in the realignment of the lower extremity’s anatomical axis, adequate implant orientation and design, good implant fixation, proper soft tissue balancing, and stability. A good exposure also allows optimal placement of the components. Our preferred approach is the median parapatellar approach in most cases. However, the orthopedic surgeon may face anatomical variants associated with knee types that may complicate the classic approach. We are reviewing multiple surgical approaches also used by us in our clinic in total knee arthroplasty, as well as additional techniques in these surgical approaches. The MIS approach can be used in many cases to reduce pain and speed the healing process. All of the total knee arthroplasty approaches are detailed with anatomical illustrations along with advantages and disadvantages of each. The ultimate goal is to restore knee function as quickly as possible and to preserve the anatomical integrity of the joint.

Novel Surgical Technique for Bone Marrow Lesion — Case Report

Abstract Introduction: Bone marrow lesions (BMLs) are commonly described as magnetic resonance imaging (MRI) findings associated with stress injuries or trauma. The presence of BMLs closely correlates with pain and rapid joint deterioration. Case presentation: A 51-year-old healthy man presented to our clinic with severe knee pain due to BMLs. After 3 months of conservative treatment, arthroscopy and subchondroplasty (SCP) of the medial femoral condyle was performed. The IKDC (International Knee Documentation Committee) score improved from 39.9 to 66.7 at 6 months, and to 87.4 at 1 year after surgery. The KOOS (Knee Injury and Osteoarthritis Outcome) score improved from 38.5 to 77.7 at 6 months, and to 92.6 at 1 year after surgery. The Tegner Lysholm score improved from 23 to 80 at 6 months, and to 95 at 1 year after surgery. Conclusion: SCP may provide a viable approach to reduce pain associated with BML, with minimal risk of significant complications.

Trochanteric fracture following hip arthrodesis: case presentation

Even if the intertrochanteric fracture under an arthrodesis hip is rare and the optimal surgical treatment is controversial, we consider that treating this kind of fracture with a locked plate was a success.

Autograft Options for ACL Reconstruction. Which is Best

Abstract Anterior cruciate ligament (ACL) tears are commonly seen in orthopedic practice, and usually restoration is recommended to re-establish normal knee function. Autografts and allografts are viable options. Among autografts the main sources are the patellar tendon, the hamstrings and the quadriceps tendon, each having advantages and drawbacks. Many factors should be taken into consideration when deciding on a graft source for ACL restoration; however, clinical data may aid the surgeon in choosing the right graft for every specific patient in an individualized manner. This short review is intended to highlight the main characteristics and clinical data for each type of autograft.

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

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.

Anterolateral Ligament (ALL) — Myth or Reality?

Abstract Although the anterolateral ligament (ALL) was described a long time ago, recent research shows a lot of interest regarding this structure. There is a high variability concerning its anatomy, especially its capsular/extracapsular situation and insertion sites. There is also some controversy about its ligamentous structure. It seems that it has a biomechanical role in restricting anterior tibial translation and internal rotation. The ALL complex seems to have a clinical significance, and a relationship with the pivot shift has been described. Although there are promising results recently, the surgical techniques of ALL reconstruction, in addition to anterior cruciate ligament reconstruction, have to be further investigated. A precise indication algorithm and patient selection criteria need to be established.

Single- or Double-Bundle Technique in the Anterior Cruciate Ligament Reconstruction — Current Concepts and Review of the Literature

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.