Tarsal coalition is an uncommon cause of insidious-onset foot pain typically affecting adolescents. Cuboid-navicular coalitions are among the rarest variety, comprising less than 1% of all tarsal coalitions. This case report describes a female competitive gymnast in middle childhood with a 6-month history of worsening insidious onset right foot pain that forced withdrawal from all sporting activities. The patient reported a background of intermittent foot pain and bilateral ankle instability over the past 2 years. A comprehensive history and physical examination, alongside MRI, enabled the diagnosis of a fibro-osseous cuboid-navicular coalition. Through early diagnosis, a targeted and prompt trial of non-operative management was implemented, consisting of physiotherapy, a deloading protocol, orthotics and analgesia. At 6-month follow-up, this led to improvements in pain symptoms and functional outcomes as well as a return to competitive sport. Early recognition of cuboid-navicular coalition is essential to prevent early degenerative joint disease.

Epithelioid haemangioendothelioma (EH) is a rare malignant vascular tumour occurring mainly in the liver and lungs, with bones being a rare site and primarily seen in the adult population. This case presents a male patient in his 40s who presented to the outpatient department with a chief issue of a painless swelling over the inguinal region for 4 months, gradually increasing in size, along with a history of a gradually enlarging, painless mass on his left knee over the past 5 years. Despite occasional discomfort during physical activities, the mass exhibited no associated trauma, fever, weight loss or systemic symptoms. Physical examination revealed a firm mass on the left knee and a matted lymph nodal swelling in the left inguinal region. Subsequent imaging studies identified multiple soft tissue lesions, osseous involvement and pulmonary metastases, suggestive of multicentric haemangioendothelioma. The patient underwent surgical excision of the inguinal mass and fixation of a pathological fracture in the left femur. He is currently undergoing chemotherapy and is scheduled for regular follow-up appointments. This case underscores the importance of thorough diagnostic evaluation and multidisciplinary management in complex oncological conditions like multicentric haemangioendothelioma.

We present a case of a fit man in his 50s, with simultaneous bilateral quadriceps tendon repair of injuries sustained 6 years apart. Spontaneous closed ruptures of the quadriceps tendon are uncommon. Clinical data of a single case of bilateral quadriceps tendon injury with simultaneous repair was gathered via the patient, notes and surgeon. Diagnosis was primarily based on history and clinical examination. Suggestive features on the plain radiographic imaging were also present. Confirmation was attempted using ultrasonography but yielded conflicting reports. The patient was screened for any associated predisposing conditions that would preclude surgical intervention or increase risk of recurrence. Repairs were accomplished by employing a combination of suture anchors and transpatellar cerclage reinforcement. Apposition of the tendon to the superior patellar pole was successful although with decreased passive flexion on the neglected side (approximately 30°) compared with the acute (approximately 90°). Follow-up continues with postoperative rehabilitation.

Mucoid degeneration of the anterior cruciate ligament (ACL) can be treated with arthroscopic debridement, however, instability can ensue. Here, we present a fit and active woman in her 60s with severe mucoid degeneration of the ACL who underwent conservative arthroscopic debridement and treatment with intraligamentous administration of platelet-rich plasma (PRP). After 1 month, the patient demonstrated significant improvements in range of motion and pain symptoms, with nil resultant laxity. The patient was able to return to all recreational sporting activities and professional duties. Quantitative MRI conducted 6 months postoperatively revealed improved fibre orientation and formation of new parallel fibres. Compared with the preoperative scan, the mean grey value demonstrated darker pixel intensity with a smaller standard deviation (SD), potentially indicating a more uniform and less variable formation of ligamentous tissue. Therefore, PRP did not cause harm and was associated with benefit in combination with arthroscopic debridement.

The fabella is an inconstant sesamoid bone. A handful of cases have been reported so far describing fabella fracture, usually involving high energy mechanism or stress fractures after total knee arthroplasty. This paper presents a fabella fracture in a man in his 40s after suffering a car crash, the clinical and radiographic presentation, treatment and complete recovery at 4-months follow-up.

Knee dislocations are severe injuries difficult to treat. Specially in low-resources scenarios, reconstruction of multiple ligaments can be challenging. We describe a technical note that can be reconstruct multi ligaments using ipsilateral hamstrings autograft. A posteromedial knee incision is made to visualise the medial corner of the knee and to reconstruct medial collateral ligament (MCL) and posterior cruciate ligament (PCL) with semitendinosus and gracilis tendon graft, using one femoral tunnel from the anatomic femoral insertion of the MCL to the anatomic femoral insertion of the PCL. After 1-year follow-up, the patient returned to his previous function with a Lysholm score of 86. This technique can reconstruct more than one ligament anatomically with limited graft resource.

Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.

A 65-year-old woman with chronic low back pain participated in a 1-week community walking poles course. Although the participant received instruction in the standard Nordic walking method, she independently adopted a novel, modified, two-point gait pattern. Subsequently, her pain and activity tolerance using walking poles were monitored at 6 and 12 months. The participant ambulated two times the distance and reported lower ratings of perceived exertion and pain at 6-month and 12month follow-ups when walking with poles compared with walking without poles. This case highlights the potential effect of respecting patient preference within the clinical decision-making model. Doing so empowered a participant with chronic low back pain to adopt a novel, self-selected gait pattern and improve her short-term and long-term outcomes associated with chronic musculoskeletal disease.

Secondary lymphoedema due to filariasis is a leading cause of morbidity in India. We present a case of a 54-year-old female with lymphatic filariasis for 18 years, with three to four episodes of acute dermato-lymphangio-adenitis (ADLA) every year. The patient had voluntarily restricted social interaction and community participation. A combination of interventions provided in 17 physiotherapy sessions over a period of 20 days showed notable improvement, by reducing limb volume and ADLA episodes and by improving limb shape, functional capacity and quality of life. Interventions included aerobic exercise, decongestion therapy with faradism under pressure and exercises with elevation. This gain was maintained throughout the 8 months of the pandemic. Patient education and counselling along with home programme of self-bandaging and self-limb hygiene played a major role in the recovery of the patient. Self-reliance in management was important because of the pandemic, which restricted the patient from attending the outpatient department.

Ganglion cysts of the psoas tendon are uncommon and rarely reported in the literature. Often they remain asymptomatic and are found incidentally or can be a cause of atypical groin/hip pain. We present a rare case of ganglion cyst in a child arising from the psoas tendon, causing symptomatic hip pain, which failed non-surgical treatment and eventually successfully treated with surgical excision.