A knee radiograph of a 12-year-old boy with recurrent hemarthrosis due to hemophilia A shows widening of the intercondylar notch, squaring of the inferior patella, and subchondral cysts. Which structure is responsible for the characteristic widening of the intercondylar notch?

• A Hypertrophy of the cruciate ligaments
• B Displaced meniscal fragments lodging in the notch
• C Overgrowth of the tibial spines
• D Synovial hypertrophy and chronic inflammatory pannus eroding the notch walls ✓

Explanation

Recurrent intra-articular hemorrhage in hemophilia leads to chronic hemosynovitis. Hypertrophic iron-laden synovium forms a pannus that erodes the intercondylar notch walls, producing the classic widened intercondylar notch along with squared patella and subchondral cysts. The cruciate ligaments themselves are not hypertrophied, tibial spine overgrowth is not the mechanism, and meniscal fragments are unrelated. Recognising these changes distinguishes hemophilic arthropathy from juvenile idiopathic arthritis.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.