Gouty Arthritis Versus Chondrocalcinosis in a Stiff Knee, A Diagnostic Dilemma - A Case Report

Isolated tophaceous gout of the knee is a rare presentation, requiring a high degree of suspicion to differentiate it from chondrocalcinosis. If left untreated, chronic tophaceous gout can cause internal derangements and cartilage damage to the knee.

A 32-year-old male presented with a painful, swollen knee joint with stiffness. Magnetic resonance imaging (MRI) showed Arthrofibrosis with features of synovitis. Arthroscopic evaluation showed synovitis with chalky deposits over the chondral surfaces, menisci, anterior cruciate ligament and over synovium, which was typical of chondrocalcinosis, but histopathological analysis revealed uric acid crystals. Arthroscopic debridement of tophi with arthrolysis and partial synovectomy was done. The patient had a reduction in pain, and his range of movements improved.

Isolated tophaceous gout of the knee is rare; a strong index of suspicion is necessary to come to a diagnosis. MRI and arthroscopy findings can be deceiving; hence, histopathology and synovial fluid analysis are necessary to confirm the diagnosis. The arthroscopic management can yield good clinical outcomes.