Scrub typhus is a common cause of acute febrile illness in endemic regions; however, musculoskeletal involvement is usually limited to myalgia, and true inflammatory arthritis is rarely reported. We describe a 19-year-old previously healthy male military recruit who presented with a two-month history of progressive bilateral knee swelling and left ankle pain, accompanied by fever, weight loss, and lymphadenopathy. Clinical evaluation revealed inflammatory oligoarthritis with culture-negative synovial fluid. Given the chronicity of symptoms and systemic features, tubercular and septic arthritis were initially considered. Imaging showed preserved joint architecture, and synovial fluid analysis demonstrated inflammatory features without microbial growth. Investigations for tuberculosis, autoimmune disorders, and other tropical infections were negative. Serological testing was positive for scrub typhus immunoglobulin M using a rapid immunochromatographic assay. Following the initiation of doxycycline therapy, the patient showed rapid clinical improvement with resolution of fever and marked reduction in joint symptoms. This case highlights an uncommon presentation of scrub typhus-associated inflammatory oligoarthritis mimicking tubercular arthritis in endemic regions. Clinicians should consider scrub typhus in patients presenting with febrile oligoarthritis and culture-negative joint effusion, as early recognition and appropriate treatment can result in excellent outcomes.

Charcot neuroarthropathy (CN) of the knee in adolescents with congenital insensitivity to pain with anhidrosis (CIPA) is exceptionally rare and presents unique diagnostic and therapeutic challenges. We present the case of a 13-year-old girl with genetically confirmed CIPA and a two-year history of recurrent knee swelling, effusion, and functional limitation. Imaging revealed intra-articular loose bodies and osteochondral defects in the left knee. The patient was treated with arthroscopic synovectomy and removal of a large loose body via standard anteromedial, anterolateral, and posteromedial portals. Intraoperative findings included extensive synovial proliferation and a 3 × 4 cm mobile loose body. Postoperatively, the patient followed a function-based rehabilitation protocol. At 30 days, she ambulated without assistive devices. At 1-year and 17-month follow-up, she demonstrated sustained clinical improvement with increased Lysholm score (from 50 to 82) and enhanced range of motion (from 10°-110° to 0°-140°). Magnetic resonance imaging (MRI) confirmed joint stability and absence of recurrent loose bodies. This case illustrates that arthroscopic management may offer a joint-preserving option in carefully selected adolescents with CIPA-associated Charcot knee and persistent mechanical symptoms. The approach may function as a temporizing measure to delay more invasive reconstructions. Adherence to protective joint education and close follow-up are essential in this population. This report highlights the clinical presentation, technical considerations, and mid-term outcomes of arthroscopic intervention in a rare neuropathic knee condition.

Background Knee joint pathologies are a common cause of orthopedic consultation, with many requiring imaging. Magnetic resonance imaging (MRI) is considered the non-invasive imaging reference standard with superior soft tissue resolution. However, it is expensive and time-consuming. High-resolution ultrasonography (HRUS), on the other hand, provides high soft tissue resolution for superficial structures, is cheaper, and is readily available with dynamic capabilities. Methods This prospective study was carried out on 50 patients referred from orthopedics to the radiology department of Government Medical College and Hospital, Jammu, with a request for MRI of the symptomatic knee joint. All patients underwent USG first, followed by MRI with standard knee protocol on a 1.5 T Siemens MRI (Munich, Germany). MRI was used as the reference standard. Ultrasonography (USG) findings were compared with MRI findings, and diagnostic indices, including sensitivity, specificity, accuracy, positive predictive value, and negative predictive value, were calculated. Results The anterior cruciate ligament and the medial meniscus were the most commonly damaged structures. HRUS showed low sensitivity (46.1% and 40%, respectively) but high specificity (95.8% and 97.5%, respectively) for medial and lateral meniscus injuries. Diagnostic performance of USG was excellent for superficial structures, including collateral ligaments, tendons, synovitis, collections, and popliteal cysts, with specificity approaching 100%. Joint effusion detection showed 94.7% sensitivity and 100% specificity. However, the cruciate ligaments were poorly visualized on USG. Conclusion Although MRI remains the gold standard for thorough evaluation of knee pathologies, USG has shown strong specificity and good diagnostic performance for superficial soft tissue structures. Therefore, USG may serve as a valuable screening tool, particularly in resource-limited settings.

Anterior Cruciate Ligament (ACL) injuries in the knee are common orthopedics injuries, affecting patients of various ages and activity levels. Now-a-days use of quadriceps tendon (QT) autograft has been steadily increasing for ACL reconstruction. This Prospective interventional study was conducted in the Department of Orthopedic Surgery, Bangladesh Medical University (BMU), Bangladesh from March 2020 to August 2022 to evaluate the Functional outcome of arthroscopic isolated ACL reconstruction with quadriceps tendon. Within this period, a total number of 30 cases of ACL injury of knee that required surgery were selected as study sample. Visual analogue scale (VAS), Lysholma and Tegner activity level score were used to assess the outcome of Arthroscopic isolated ACL reconstruction with Quadriceps tendon. All the data were analyzed statistically by using statistical package for social science (SPSS-25.0). The results of present study demonstrate that the preoperative mean±SD VAS, Lysholm and Tegner activity level score were respectively 0.90±1.77 and postoperative mean VAS score was 0.20±0.48.VAS (p=0.001) and preoperative Lysholm score was 48.57±7.41 (range: 40-64) and postoperative score was 89.63±4.18 (range: 81-96). P-value was statistically significant. Statistically, the preoperative Lysholm score was found to be poor in all cases. Nine months after isolated arthroscopic ACL reconstruction with quadriceps tendon Lysholm score was found as excellent in 18(60.0%) cases, good in 8(26.7%) and fair in 4(13.3%) cases. Tegner activity level score was 3.03±1.03 (range: 2-5) which was 7.10±1.12 (range: 4-9) at final follow-up after 9 months postoperatively. Improvement from pre-operative to 9 months post-operative value (<0.001) was statistically significant. During the study, one patient developed infection (3.3%) and five patients developed effusion (16.7%). Complications of these patients were treated conservatively. Arthroscopic isolated ACL reconstruction showed satisfactory functional outcome for the treatment of ACL injury and allows recovery of the pre-injury level of activity.