Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes.

Objective: This study aimed to examine the relationship between lumbosacral transitional vertebra (LSTV), classified by Castellvi’s system, and lumbar disc degeneration, graded using Pfirrmann’s classification, based on radiological assessment. Methods: This retrospective study analyzed 2516 patients (1548 females and 968 males) with a mean age of 51.83 ± 15.6 years withchronic low back pain who underwent lumbosacral magnetic resonance imaging and computed tomography scans at a single centerbetween January 2018 and January 2021. Pfirrmann grading was used to assess L4-L5 intervertebral disc degeneration, and Castellviclassification determined the anatomical type of LSTV. Correlation analysis was performed to evaluate the association between LSTVpresence and disc degeneration. Additionally, a proportional-odds ordinal logistic regression model was used to examine the relationship between Pfirrmann grade and patient-specific factors (age, gender, and LSTV presence). Results: According to Pfirrmann classification, 113 patients were grade I, 402 were grade II, 877 were grade III, 861 were grade IV, and 263 were grade V. A total of 771 patients (30.6%) did not have LSTV, while the remaining 1745 patients (69.4%) had LSTV. A statistically significant association was found between LSTV presence and Pfirrmann grade (P < .001, r=.200). Patients with LSTV had 0.75 times higher probability (95% CI: 0.58–0.90, P < .001) of exhibiting a higher Pfirrmann grade compared to those without LSTV. However, no significant correlation was observed between LSTV subtypes classified by Castellvi and Pfirrmann grade (P=.379). Additionally, age was significantly correlated with Pfirrmann classification, LSTV presence, and Castellvi classification (P < .001). Female patients had 1.34 times higher likelihood (95% CI: 1.19–1.49, P < .001) of exhibiting a higher Pfirrmann grade compared to male patients. Conclusions: This study highlights the significant association between LSTV and advanced disc degeneration, establishing LSTV as apotential risk factor for progressive spinal changes. It emphasizes the importance of early detection and targeted management, particularly for older adults and females who are more susceptible to severe degenerative changes. Cite this article as: Bayram S, Altin YF, Kahraman A, Ya!ci TF, Korkmaz M, Akgül T. Presence of sacralized lumbar vertebra predisposes to adjacent level lumbar disc degeneration: A cross-sectional study. Acta Orthop Traumatol Turc., 2025;59(2):117-121.

The Dias-Tachdjian classification is the most commonly used system for the classification of pediatric ankle fractures, but its inter- and intra-observer reliability has not been studied in detail. Also, the impact of the clinician’s experience and expertise on the reliability of this system is unknown. This study aimed: (1) to determine the intra- and inter-observer reliability of the Dias-Tachdjian classification and (2) to investigate the effect of the clinician’s experience and expertise on the reliability of this system. Anteroposterior and lateral ankle radiographs of 56 children (34 male, 22 female) with ankle fractures, aged between 3 and 14 years, with open growth cartilages, were retrospectively identified and included in the study. Each patient radiograph was examined by 10 observers from two different specialties with different levels of clinical experience (two orthopedic surgeons with interest in pediatric orthopedics, three orthopedic surgeons with no interest in pediatric orthopedics, three orthopedic residents, and two radiology specialists) from two different specialties (orthopedics and radiology). All observers were then asked to classify pediatric ankle fractures at 6-week intervals per the Dias-Tachdjian classification system. Overall, intra-observer reliability as substantial to very good (κ = 0.77–0.95, P < 0.01), but inter-observer reliability as fair for both assessments (κ = 0.21, P < 0.01 and κ = 0.20, P < 0.01 for the first and second occasions, respectively). Inter-observer reliability among pediatric orthopedic surgeons as very good (κ = 0.90, 95% CI = 0.86–0.94, P < 0.01 and κ = 0.82, 95% CI = 0.71–0.93, P < 0.01 for the first and second occasions, respectively). Orthopedic surgeons with no special interest in pediatric orthopedics demonstrated substantial agreement in the first occasion (κ = 0.63, 95% CI = 0.53–0.72, P < 0.01) but moderate in the second one. Orthopedic residents exhibited moderate levels of agreement in each assessment period (κ = 0.58, 95% CI = 0.47–0.68, P < 0.01 and κ = 0.44, 95% CI = 0.37–0.51, P < 0.01 for the first and second occasion, respectively). Considering that the specialists dealing with pediatric orthopedics show very good consistency for Dias-Tachdjian classification, both within and between observers, consistency in the identification of the ankle fracture models increases as the interest in the field of pediatric orthopedics intensifies.

Background/Objectives: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population.

Background/Objective: The anterior vertebral body tethering (AVBT) technique, which preserves spinal mobility and avoids possible fusion problems in adolescent idiopathic scoliosis (AIS) patients, continues to be increasingly used in spine surgery. The study aims to report the early-to-early-mid postoperative radiological results of thoracolumbar/lumbar AVBT on sagittal alignment, and the second aim is to compare AVBT with selective thoracic fusion (STF) and non-selective fusion (NSF) groups in AIS patients. Methods: Patients with a diagnosis of AIS were retrospectively evaluated in the study. All patients were categorized into three groups based on the surgical technique performed: AVBT (n = 17), NSF (n = 19), and STF (n = 15). The major curvature degree, coracoid height difference (CHD), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), C7 tilt, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and T1 spinopelvic inclination (T1SPI) were measured for radiological comparison. Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) scores were used at the final follow-up for functional evaluation. Results: The T1SPI value of the NSF group was significantly higher than the STF group in the final follow-up (p = 0.033). The mean decrease of 8.85 ± 7.85 units in the final follow-up value compared to the postoperative CHD value of the patients in the AVBT group was found to be significant (p = 0.028). Statistically significant differences were found between preoperative and the first postoperative CL and TPA measurements (p = 0.001 and p = 0.042, respectively), as well as between preoperative and final follow-up CL measurements in the AVBT group (p = 0.001). No statistically significant differences were observed between the groups in CHD, SS, PT, PI, LL, TK, CL, C7 tilt, SVA, and TPA values (p > 0.05); similarly, the SRS-22 and ODI scores did not differ significantly among the groups (p > 0.05). Conclusions: Thoracolumbar/lumbar AVBT surgery led to significant improvements in shoulder asymmetry and cervical lordosis of AIS patients in the early to early-mid postoperative period. However, compared with spinal fusion techniques, thoracolumbar/lumbar AVBT did not demonstrate superiority in functional scores or sagittal parameters. The mid- to long-term benefits of thoracolumbar/lumbar AVBT remain uncertain and require further investigation.