OBJECTIVE: For people with haemophilia A (PwHA), bleeding in the joints leads to joint damage and haemophilia-related arthropathy, impacting range of motion and life expectancy. Existing guidelines for managing haemophilia A support healthcare professionals (HCPs) and PwHA in their efforts to preserve joint health. However, such guidance should be reviewed, considering emerging evidence and consensus as presented in this manuscript.
METHODS: Fifteen HCPs experienced in the management of PwHA in the UK participated in a three-round Delphi panel. Consensus was defined at ≥70% of panellists agreeing or disagreeing for Likert-scale questions, and ≥70% selecting the same option for multiple- or single-choice questions. Questions not reaching consensus were revised for the next round.
RESULTS: 26.8% (11/41), 44.8% (13/29) and 93.3% (14/15) of statements reached consensus in Rounds 1, 2 and 3, respectively. HCPs agreed that prophylaxis should be offered to patients with a baseline factor VIII (FVIII) level of ≤5 IU/dL and that, where there is no treatment burden, the aim of prophylaxis should be to achieve a trough FVIII level ≥15 IU/dL and maintain a longer period with FVIII levels of ≥20-30 IU/dL to provide better bleed protection. The aspirational goal for PwHA is to prevent all joint bleeds, which may be achieved by maintaining normalised (50-150 IU/dL) FVIII levels.
CONCLUSIONS: The panel of experts were largely aligned on approaches to preserving joint health in PwHA, and this consensus may help guide HCPs.

(Ultrasound of the Hand (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the hand and the fingers. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie der Hand und der Finger erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

Ultrasound of the Foot (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the foot including the ankle, midfoot and the toes. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie des Fusses erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

Ultrasound of the Knee (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the knee. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie des Knies erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

Ultrasound of the Hip (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the hip. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie der Hüfte erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

Ultrasound of the Elbow (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the elbow. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie des Ellenbogens erläutert. Hierbei werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Fundierte Kenntnisse der sonografischen Anatomie sind unabdingbar, um Pathologien zu erkennen.

Ultrasound of the Shoulder (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the shoulder. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.
Zusammenfassung. In dieser Übersichtsarbeit wird die vereinfachte Ultraschallanatomie der Schulter erläutert. Es werden die adaptierten grundlegenden Standardebenen nach SGUM-Richtlinien im Detail beschrieben und anhand einer Auswahl von hochauflösenden Ultraschall-Bildern illustriert. Um Pathologien zu erkennen, sind fundierte Kenntnisse der sonografischen Anatomie unabdingbar.

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: Early joint damage in patients with haemarthrosis often escapes diagnosis because of insufficient investigation of biomechanical changes. Arthropathy in haemophilia requires complex assessment with several tools. Considering the increased emphasis on an integrated approach to musculoskeletal (MSK) outcomes, re-evaluation of MSK assessment to address individual patient needs is warranted. To advise on the optimal use of current assessment tools and strategies for tailored MSK evaluation in patients with haemophilia. A panel of experts in haemophilic arthropathy evaluated internationally recognized assessment tools through published literature and personal expertise. Each tool was considered, scored and ranked for their utility in the clinical assessment of MSK damage. Subsequently, a patient evaluation table detailing advice on type and frequency of assessments for different patient populations was constructed. To obtain a complete MSK assessment, multiple tools must be used to ensure each criterion is evaluated. For patients with haemophilia, clinical examination of the joint, disease-specific structure/function scores, and activity/participation scores including quality of life are important, and should be performed on a regular basis according to age and clinical condition. Joint imaging is recommended in the prevention, diagnosis and follow-up of haemophilic arthropathy and should be used in conjunction with joint structure and function scores. An integrated approach to MSK assessment using combinations of tools will allow earlier management of dysfunction and may improve long-term outcomes. This approach could be used in long-term follow-up of all patients independent of age and disease stage, especially in children to prevent arthropathy.

Experts recently identified 49 joint motion patterns in children with cerebral palsy during a Delphi consensus study. Pattern definitions were therefore the result of subjective expert opinion. The present study aims to provide objective, quantitative data supporting the identification of these consensus-based patterns. To do so, statistical parametric mapping was used to compare the mean kinematic waveforms of 154 trials of typically developing children (n = 56) to the mean kinematic waveforms of 1719 trials of children with cerebral palsy (n = 356), which were classified following the classification rules of the Delphi study. Three hypotheses stated that: (a) joint motion patterns with \'no or minor gait deviations\' (n = 11 patterns) do not differ significantly from the gait pattern of typically developing children; (b) all other pathological joint motion patterns (n = 38 patterns) differ from typically developing gait and the locations of difference within the gait cycle, highlighted by statistical parametric mapping, concur with the consensus-based classification rules. (c) all joint motion patterns at the level of each joint (n = 49 patterns) differ from each other during at least one phase of the gait cycle. Results showed that: (a) ten patterns with \'no or minor gait deviations\' differed somewhat unexpectedly from typically developing gait, but these differences were generally small (≤3°); (b) all other joint motion patterns (n = 38) differed from typically developing gait and the significant locations within the gait cycle that were indicated by the statistical analyses, coincided well with the classification rules; (c) joint motion patterns at the level of each joint significantly differed from each other, apart from two sagittal plane pelvic patterns. In addition to these results, for several joints, statistical analyses indicated other significant areas during the gait cycle that were not included in the pattern definitions of the consensus study. Based on these findings, suggestions to improve pattern definitions were made.