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CC BY 4.0 · Surg J (N Y) 2019; 05(02): e46-e49
DOI: 10.1055/s-0039-1692675
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Treatment of Patellar Tendon Gouty Tophus: A Case Report

Theodoros Bouras 
1   Department of Sports Knee Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
,
Maulik Gandhi∗
1   Department of Sports Knee Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
,
Andrew Barnett∗
1   Department of Sports Knee Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Publication History

30 January 2019

20 May 2019

Publication Date:
18 June 2019 (online)

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Abstract

The main aim of this case report is to thoroughly describe the steps of diagnosis and treatment in the rare incidence of patellar tendon gouty tophus. The case of a 53-year-old man manual worker who was treated with open excision of the lesion, following failure of extended medical treatment with rheumatological input, is presented. Surgical treatment led to full restoration of the patient's knee function. Open or arthroscopic surgery is a viable option for the unusual case of intratendinous patellar gouty deposition if the patient fails medical management. Medical treatment should still be the mainstay.

Keywords

gout - patellar tendon - tophaceous - deposits - treatment
 

  • References

  • 1 Roddy E, Choi HK. Epidemiology of gout. Rheum Dis Clin North Am 2014; 40 (02) 155-175
    CrossrefPubMedGoogle Scholar
  • 2 Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol 2011; 23 (02) 192-202
    CrossrefPubMedGoogle Scholar
  • 3 Ventura-Ríos L, Sánchez-Bringas G, Pineda C. , et al. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 2016; 35 (08) 2039-2044
    CrossrefPubMedGoogle Scholar
  • 4 Mallinson PI, Reagan AC, Coupal T, Munk PL, Ouellette H, Nicolaou S. The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases. Skeletal Radiol 2014; 43 (03) 277-281
    CrossrefPubMedGoogle Scholar
  • 5 Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum 2012; 42 (02) 146-154
    CrossrefPubMedGoogle Scholar
  • 6 Fritz J, Henes JC, Fuld MK, Fishman EK, Horger MS. Dual-energy computed tomography of the knee, ankle, and foot: noninvasive diagnosis of gout and quantification of monosodium urate in tendons and ligaments. Semin Musculoskelet Radiol 2016; 20 (01) 130-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hui M, Carr A, Cameron S. , et al; British Society for Rheumatology Standards, Audit and Guidelines Working Group. The British Society for Rheumatology guideline for the management of gout. Rheumatology (Oxford) 2017; 56 (07) 1246
    CrossrefPubMedGoogle Scholar
  • 8 Gililland JM, Webber NP, Jones KB, Randall RL, Aoki SK. Intratendinous tophaceous gout imitating patellar tendonitis in an athletic man. Orthopedics 2011; 34 (03) 223
    CrossrefPubMedGoogle Scholar
  • 9 Rodas G, Pedret C, Català J, Soler R, Orozco L, Cusi M. Intratendinous gouty tophus mimics patellar tendonitis in an athlete. J Clin Ultrasound 2013; 41 (03) 178-182
    CrossrefPubMedGoogle Scholar
  • 10 Kester C, Wallace MT, Jelinek J, Aboulafia A. Gouty involvement of the patella and extensor mechanism of the knee mimicking aggressive neoplasm. A case series. Skeletal Radiol 2018; 47 (06) 865-869
    CrossrefPubMedGoogle Scholar
  • 11 Jabour P, Masrouha K, Gailey M, El-Khoury GY. Masses in the extensor mechanism of the knee: an unusual presentation of gout. J Med Liban 2013; 61 (03) 183-186
    PubMedGoogle Scholar
  • 12 McQueen FM, Reeves Q, Dalbeth N. New insights into an old disease: advanced imaging in the diagnosis and management of gout. Postgrad Med J 2013; 89 (1048): 87-93
    CrossrefPubMedGoogle Scholar
  • 13 Colberg RE, Henderson RG. Diagnosis and treatment of gouty tophi in the patellar tendon using ultrasound-guided needle barbotage: a case presentation. PM R 2017; 9 (09) 938-942
    CrossrefPubMedGoogle Scholar
  • 14 Neogi T, Jansen TLTA, Dalbeth N. , et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015; 74 (10) 1789-1798
    CrossrefPubMedGoogle Scholar
  • 15 Pascart T, Richette P. Current and future therapies for gout. Expert Opin Pharmacother 2017; 18 (12) 1201-1211
    CrossrefPubMedGoogle Scholar
  • 16 Soskind R, Abazia DT, Bridgeman MB. Updates on the treatment of gout, including a review of updated treatment guidelines and use of small molecule therapies for difficult-to-treat gout and gout flares. Expert Opin Pharmacother 2017; 18 (11) 1115-1125
    CrossrefPubMedGoogle Scholar
  • 17 Yuan Y, Liu C, Xiang X. , et al. Ultrasound scans and dual energy CT identify tendons as preferred anatomical location of MSU crystal depositions in gouty joints. Rheumatol Int 2018; 38 (05) 801-811
    CrossrefPubMedGoogle Scholar
  • 18 Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM. Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis 2013; 72 (09) 1545-1548
    CrossrefPubMedGoogle Scholar
  • 19 Lui TH. Endoscopic resection of gouty tophus of the patellar tendon. Arthrosc Tech 2015; 4 (04) e379-e382
    CrossrefPubMedGoogle Scholar
  • 20 Cimşit C, Buğdayci O, Aribal ME. Unusual presentation of gout: intratendinous tophus in the patellar tendon. Arch Rheumatol 2015; 31 (01) 104-106
    PubMedGoogle Scholar
  • 21 Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis 1996; 55 (12) 921-923
    CrossrefPubMedGoogle Scholar