Arthroscopic Management of Intra-articular Tophaceous Gout of the Knee: A Case Report and Review of the Literature

INTRODUCTION: Surgical management of intra-articular tophaceous gout has been previously described but not widely reported in the literature. Therefore, when faced with clinical decision-making regarding this entity, the surgeon may be unfamiliar with the diagnosis, appropriate management, and outcomes related to treatment. CASE REPORT: A 42-year-old male oil field worker who presented with the right knee intra-articular tophaceous gout deposits resulting in mechanical symptoms. The pathology was diagnosed intraoperatively while performing knee arthroscopy for what was presumed to be a meniscal tear. The patient underwent arthroscopic debridement of the tophi and partial meniscectomy. The tophaceous gout deposits were debrided with an arthroscopic liberator which allowed for the protection of the underlying articular cartilage. Postoperatively, he was begun with aggressive range of motion exercises and was referred to a rheumatologist for gout medical management. The patient improved significantly in regard to pain and range of motion and was able to return to full duty by 6weeks postoperatively. CONCLUSIONS: Tophaceous gout of the knee can mimic intra-articular pathology and may be encountered unexpectedly when performing a knee arthroscopy. The treating surgeon should be aware of the potential for this condition and understand that surgical intervention, when combined with appropriate medical management, can yield favorable clinical results.