A clinical study of patients with mild haemophilia A to document the frequency and severity of arthropathy has not been previously published. We studied ankle arthropathy in 34 patients with mild/moderate haemophilia A. The patients were assessed for the presence and severity of pain, and by the physical and radiological scoring systems for the evaluation of haemophilic arthropathy recommended by the World Federation of Haemophilia (WFH). Of the 34 patients, 16 (47%) had ankle pain, which was of moderate to severe degree in nine patients, and associated with limitation of physical activities in 13 patients. Of 33 patients examined by radiology 17 (52%) were positive for ankle arthropathy, and of these, 16 were also positive by the physical score. The presence and severity of ankle arthropathy was more common in patients with a one-stage factor VIII level of less than or equal to 11 IU/dl. There was a significant relationship between the presence of ankle arthropathy and a history of bleeds into the ankle joint as a child. We conclude that arthropathy of the ankle in these patients is common, is often severe and disabling, and is due to episodes of bleeding into the ankle joint during childhood.

We describe a case of painful snapping in the medial aspect of the knee of a 40-year-old man, following a knee hyperflexion injury. Dynamic real-time ultrasonography determined that the snapping was due to the distal tendon of sartorius passing over a medial meniscal cyst. The patient subsequently underwent arthroscopic decompression of the cyst instead of an inappropriate hamstring tendon harvest procedure, with complete resolution of symptoms.

SummaryHaemorrhage is the main manifestation of the haemophilias. Although acute haemorrhages can be life threatening, especially if involving the central nervous system, repeated haemorrhages involving the musculoskeletal system lead to two conditions unique to patients with haemophilias. This pictorial essay reviews the typical imaging appearances of haemorrhages and consequences in those with haemophilias, with particular emphasis on haemophilic arthropathy and pseudotumours.

Coalition is defined as abnormal bridging between two bones, and the connection can be osseous or nonosseous. Most coalitions in the foot involve the hindfoot. Intermetatarsal coalition is thought to be much rarer than the more common hindfoot coalitions and has only been reported sporadically in the orthopedic literature. We present two patients with nonosseous intermetatarsal coalition presenting with nonspecific dorsolateral foot pain and describe the imaging findings of intermetatarsal coalition with different modalities. We suspect that whilst rarely described, intermetatarsal coalition is quite likely a more common underrecognized entity than a rare entity. This report is aimed at increasing the awareness of coalition in this location, in the radiology community, particularly the nonosseous ones, given that this condition can be debilitating but treatable.

Lisfranc injury is increasingly being recognised in the high-performance athletic cohort, particularly in contact sports. In this cohort, there is a pattern of low-energy Lisfranc injury which combines magnetic resonance findings of both ligamentous sprain and adaptive bone stress response that infers a longer timeframe of stress than the duration of symptoms would suggest. This has not been previously described, and the authors believe that this is an unrecognized subset of midfoot sprain in the context of sustained stress to the midfoot. This retrospective case report describes MRI findings of three index cases of this entity in professional athletes presenting with acute foot pain. Two responded with conservative management whilst the third ultimately required surgery. All athletes were eventually able to return to play.