Symptomatic carrier of hemophilia A with FVIII levels at 28%. History of menorrhagia since menarche treated with hormonal therapy. Presented 3 episodes of hemarthrosis in the left knee over the past 18 months, following minor trauma (fall during sports activity, direct contusion). Episodes were managed with RICE (rest, ice, compression, elevation) and single administration of FVIII concentrates. Reports occasional joint discomfort after prolonged physical activity. Has never followed regular prophylaxis.

Knee appears normal on inspection without evident swelling. Mild tenderness on deep palpation of the suprapatellar region. No signs of acute joint effusion. Quadriceps muscle trophism preserved, symmetric compared to contralateral. Range of motion slightly reduced in maximum flexion (135° vs 140° expected) due to sensation of tension reported by patient. Ligamentous stability tests normal. Normal gait without limping. Mild discomfort during full squat.

• Quadriceps tendon: thickness at upper limit (7mm), mild focal echostructure heterogeneity
• Suprapatellar recess: mild synovial thickening (3mm), minimal fluid collection
• Patellar ligament: preserved morphology, mild localized thickening (5.5mm)
• Hoffa’s fat pad: preserved adipose echostructure with minimal focal fibrous bands
• Articular cartilage: preserved profile with minimal superficial irregularities
• Bony surfaces: regular, absence of significant erosions
• Minimal joint effusion (<3mm) in suprapatellar recess
• Mild increase in Doppler signal in synovium