Objectives: Knee osteoarthritis (OA) causes chronic pain and functional limitation in older adults, and conventional treatments often give limited long-term relief. Radiofrequency ablation (RFA) of the genicular nerves is a minimally invasive option for refractory knee pain. This study assessed the short-term effect of image-guided genicular nerve RFA (GnRF) on pain in a small retrospective series of patients with chronic knee OA. Methods: A retrospective single-center study was conducted in 21 patients (mean age 62.7 ± 5.7 years) with moderate-to-severe knee OA who had failed conservative management. Under fluoroscopic guidance, RFA was performed at 60°C for 180 s, targeting the superior medial, superior lateral, and inferior medial genicular nerves. Pain was assessed using a 10-cm Visual Analog Scale (VAS) at baseline and at 3, 6, and 12-month post-procedure. Results: Mean VAS pain scores significantly decreased from 8.9 ± 0.7 at baseline to 4.7 ± 0.9 at 3 months, 3.3 ± 0.9 at 6 months, and 2.4 ± 0.9 at 1 year ( p < 0.001). The post hoc comparisons revealed significant reductions across all time points (all p < 0.05). Conclusion: In this uncontrolled case series, GnRF was associated with a significant, progressive reduction in VAS pain scores maintained through 1 year. Without a control group, this cannot be separated from the natural course of pain or a placebo response. These preliminary findings suggest that RFA may merit further study as a non-surgical option for chronic knee OA pain in patients unfit for or unwilling to undergo knee arthroplasty.

Background: Brucellosis is a zoonotic infection with a high prevalence in endemic regions and a strong predilection for osteoarticular involvement. Brucella prosthetic joint infection (PJI) is an exceptionally rare but challenging complication of total knee arthroplasty (TKA), often characterized by delayed presentation, indolent symptoms, and diagnostic difficulty. There is no consensus regarding optimal management, particularly concerning surgical strategy and duration of antimicrobial therapy. Methods: A narrative literature review was conducted using PubMed and Scopus, searched on 1 March 2026 to identify reported cases of Brucella PJI following TKA. Cases were included based on microbiological or serological confirmation of Brucella infection. The screening process, exclusion criteria, and handling of duplicate reports are described in the Methods, and the selection process is summarized in a flow diagram. Case presentation: We report the case of a 67-year-old male farmer who keeps sheep and presented four years after bilateral TKA with a three-week history of progressive pain and swelling of the right knee, without systemic symptoms. Laboratory evaluation revealed a markedly elevated C-reactive protein with a normal leukocyte count. Ultrasound-guided joint aspiration and subsequent intraoperative cultures confirmed Brucella species infection, supported by a positive Rose Bengal test and a standard agglutination titre above 1:160. Imaging demonstrated loosening of the tibial component with scintigraphic findings suggestive of PJI. The patient was treated with prolonged anti-brucellosis therapy followed by first-stage revision arthroplasty, including complete implant removal, extensive debridement, and insertion of an antibiotic-loaded articulating cement spacer. Postoperatively, he received combination doxycycline and rifampin therapy with an uncomplicated clinical course. Brucella was still recovered from the intraoperative cultures despite a completed three-month preoperative course, and a second three-month course was given. Second-stage reimplantation was performed on November 19, 2025, with negative intraoperative cultures. At the most recent review on May 11, 2026, approximately six months after reimplantation, he was pain free with a range of motion of 0° to 120°, a normal C-reactive protein, and no evidence of recurrence. Results: Forty cases of Brucella PJI after TKA were identified. Most presented years after index surgery with non-specific symptoms. Management strategies varied, with implant stability guiding the choice between medical therapy alone and surgical revision, most commonly a two-stage approach. Conclusion: Brucella PJI should be considered in painful arthroplasties in endemic settings. Successful management requires a high index of suspicion, appropriate microbiological diagnosis, prolonged combination antimicrobial therapy, and individualized surgical intervention based on implant stability. Persistence of Brucella in intraoperative cultures despite three months of appropriate systemic therapy, as seen here, argues that implant retention is inadequate once components are radiographically loose.

Background/Objectives: An accurate understanding of anterior cruciate ligament (ACL) morphology is essential for individualized surgical planning in ACL reconstruction. Morphometric parameters of the knee, including the femoral notch width and surrounding soft tissue characteristics, may influence native ACL dimensions and potentially assist in preoperative graft sizing. Methods: This retrospective case–control study analyzed medical records, radiographs, and knee magnetic resonance imaging (MRI) performed at a tertiary academic medical center. Variables collected included femoral notch width, thigh thickness, and ACL attachment dimensions at the femoral and tibial insertions. Comparisons between patients with ACL tears and those with intact ACLs were also performed. Correlation analyses were performed to evaluate associations between morphometric parameters and ACL attachment size. Multivariable linear regression models were constructed to identify independent predictors after adjusting for age, sex, body mass index (BMI), limb side (left or right leg), and ACL status. Results: A total of 600 participants were included. The mean femoral notch width was 21.55 ± 6.15 mm, and the mean thigh thickness was 53.05 ± 11.66 mm. The mean ACL femoral and tibial attachment sizes were 8.12 ± 2.57 mm and 11.79 ± 3.89 mm, respectively. Thigh thickness demonstrated weak but significant positive correlations with both ACL femoral (r = 0.168, p = 0.001) and tibial attachment sizes (r = 0.236, p < 0.001). Femoral notch width showed a borderline association with ACL femoral attachment size (r = 0.092, p = 0.068) and a weak but significant correlation with ACL tibial attachment size (r = 0.095, p = 0.039). ACL tear group exhibited smaller thigh thickness measurements compared with controls (49.80 ± 12.00 mm vs. 55.65 ± 14.80 mm, p < 0.001) and smaller femoral notch width measurements compared with controls (21.20 ± 3.40 mm vs. 22.50 ± 3.18 mm, p = 0.001). Moreover, further analysis demonstrated that ACL tear status was associated with smaller measured ACL attachment sizes (p < 0.001). Conclusions: Thigh thickness and femoral notch width demonstrate measurable association with ACL attachment dimensions and differ between patients with ACL tears and those with intact ligaments. These findings indicate that both osseous and soft-tissue morphometric characteristics may influence ACL morphology and susceptibility to injury. Comprehensive preoperative imaging assessment of these anatomical parameters may help to optimize individualized surgical planning in ACL reconstruction.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B-cell lymphoma that typically presents as localized nodal disease. Primary extranodal involvement, particularly within soft tissue, is exceedingly uncommon and poses diagnostic and management challenges. We report a 25-year-old male who presented with a painless subcutaneous mass in the left cubital fossa. Core biopsy suggested a B-cell lymphoma with a differential diagnosis of NLPHL versus T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Comprehensive staging, including bone marrow biopsy and PET-CT, demonstrated isolated disease without nodal or visceral involvement. Wide local excision revealed classical morphologic and immunophenotypic features of NLPHL, including nodular architecture, preserved follicular dendritic cell meshworks, and LP cells expressing CD20 and B-cell transcription factors, confirming Stage IA disease. Following multidisciplinary discussion, the patient was managed with active surveillance after complete surgical excision, given the localized, asymptomatic presentation and low tumor burden. At the most recent follow-up, nine months after complete excision, the patient remained disease-free, with no clinical or laboratory evidence of recurrence. This case highlights an exceptionally rare presentation of primary extranodal NLPHL in soft tissue of the cubital fossa. It underscores the critical role of excisional biopsy in distinguishing NLPHL from THRLBCL and supports active surveillance as a feasible management strategy in carefully selected patients with completely resected Stage IA disease.

Introduction. Isolated idiopathic teres minor atrophy is a relatively understudied condition characterized by selective atrophy of the teres minor muscle without any identifiable underlying pathology. This study aimed to determine the prevalence of isolated idiopathic teres minor atrophy. Methods. Data were collected retrospectively by examining magnetic resonance imaging scans of the right and left shoulders of individuals aged 18 years or older performed at the Medical Centre of Majmaah University, Al Majma’ah, Saudi Arabia, between February 2019 and October 2022. Teres minor atrophy was classified using the original Goutallier classification system to assess fatty infiltration. In addition, demographics, including age, gender, and nationality, were collected. Associated imaging-based factors, such as teres minor and deltoid muscle edema, rotator cuff muscle tears, and injuries to the labrum and quadrilateral space, were also documented. Results. Among the 2, 194 patients studied, 59 (2.7%) were diagnosed with isolated idiopathic teres minor atrophy, aged 27 to 75 years. Females comprised 59.3% of the affected individuals, and the majority of cases were Saudi nationals (81.4%). The right side was affected in 61% of cases. Nearly half of the affected individuals (50.9%) were classified as grade 2, while 25.4% were classified as grade 4. Patients with grade 3 and grade 4 isolated idiopathic teres minor atrophy were significantly older than those with grade 2 (58.29 ± 7.12 and 57.93 ± 12.34 versus 49.96 ± 11.72, respectively (p=0.029). No statistically significant associations were found between the demographic characteristics of individuals (age and gender) and the pattern of teres minor fatty involvement. Conclusions. The incidence of isolated idiopathic teres minor atrophy was found to be 2.7%. Age was the main statistically significant factor associated with isolated idiopathic teres minor atrophy and the grade of teres minor atrophy. Other evaluated factors, including gender and the pattern of involvement, did not demonstrate any statistically significant associations.

Background/Objectives: Patella alta contributes to patellofemoral (PF) maltracking and anterior knee pain, but the agreement of patellar-height indices across imaging modalities and their clinical relevance remain uncertain. We aimed to estimate the prevalence of patella alta when using each index, quantify inter-method agreement, and quantify patella alta’s associations with Hoffa’s fat-pad impingement, patellar chondromalacia, and tibial tubercle–trochlear groove (TT–TG) distance. Methods: This retrospective cross-sectional study included 250 patients aged 18–38 years who underwent both knee radiography and MRI. Patellar height was assessed using the Insall–Salvati (IS) and modified Insall–Salvati (mIS) ratios on radiographs and MRI, and the Patellotrochlear Index (PTI) on MRI. Associations with fat-pad impingement, chondromalacia grade, and TT–TG abnormality were analyzed using the chi-square or Fisher’s exact test and as odds ratios (ORs) adjusted for age, sex, and imaged side; agreement was assessed with Cohen’s kappa (κ). Results: Patella alta prevalence was 13.2% using IS on radiographs and 10.8% using IS on MRI, but markedly lower with mIS (≤1.6%). Patella alta was more frequent in patients with Hoffa’s fat-pad impingement (31.1% vs. 5.7% on IS radiography; adjusted OR 8.83, 95% CI 3.82–20.45) and advanced chondromalacia (p = 0.025). Agreement was moderate between IS radiography and IS MRI (κ = 0.47, 95% CI 0.33–0.61) and between IS MRI and the PTI (κ = 0.43). Conclusions: The prevalence and clinical relevance of patella alta depend strongly on the measurement method. The IS ratio was the most consistent index, but radiography–MRI agreement was moderate rather than high, so the two are not interchangeable. The PTI adds information on trochlear engagement from the same MRI examination. These cross-sectional associations do not establish causation.