Anterior cruciate ligament rupture in gouty arthritis

Abstract

A 34-year-old male presented with right knee instability without any trauma. He had been diagnosed with right knee gouty arthritis 2 years prior. An arthroscopic examination revealed abundant calcific material deposited around the knee joint, including in the ACL tissue, and that the ACL was torn at the femoral attachment site. Treatment involved a synovectomy to remove calcific material, followed by an ACL reconstruction. Histology evaluation revealed gouty arthritis with the presence of tophi in the synovium, soft tissue, and ACL tissue. The case presented here indicates the possibility of pathologic rupture of the ACL associated with gouty tophus infiltration of that ligament. Level of evidence IV.

Gouty tophus presenting as an anterior cruciate ligament mass in the knee: Case report and brief review of relevant literature

“…A pre-operative joint arthrocentesis would have revealed intraarticular monosodium urate crystals, however, it wouldn't have completely ruled out an additional diagnosis. Similar to the present case, three groups reported visualizing uric acid crystals immediately after introducing the arthroscope [ 8 , 10 , 11 ]. In order to accurately diagnose a gouty tophus, it appears a dual approach using MRI and histological examination is necessary to differentiate it from PVNS and other intraarticular masses [ 1 , 2 , [8] , [9] , [10] , [11] ].…”

“…Intraarticular masses involving the ACL are rare [ 1 , 2 , [8] , [9] , [10] , [11] ]. Here we report an extremely rare case of a gouty tophus located at the origin of the ACL.…”

“…Here we report an extremely rare case of a gouty tophus located at the origin of the ACL. To our knowledge, this is one of only four cases of gouty tophi with origination at the ACL [ 8 , 10 , 11 ]. There was initial difficulty in coming to a differential diagnosis due to the ambiguous nature of the mass in MRI scans, as gouty tophi and PVNS present similarly using this modality.…”

“…Due to MRI not being a definitive factor in a differential diagnosis, other tests can be utilized. As the present case revealed, gout will manifest under high uric acid levels in the blood [ 3 , 8 , [10] , [11] , [12] ]. A combination of blood uric acid levels and past history with tophacious gout are strong differentiators for a diagnosis [ 3 , 12 ].…”

“…A combination of blood uric acid levels and past history with tophacious gout are strong differentiators for a diagnosis [ 3 , 12 ]. Visualization with the arthroscope also provides key evidence in determining the presence of gout in the synovial space [ 8 , 10 , 11 ]. In the cases where the ACL mass was gout, the patients had an established prior history [ 8 , 10 , 11 ].…”