Extra-articular Endoscopic Treatment of Lateral Malleolar Tophaceous Gout: A Case Report

Gouty tophi are chronic manifestations of gout and are typically considered extra-articular lesions; however, periarticular extension around the ankle can complicate diagnosis and surgical decision-making. Open excision of lateral malleolar tophi is often associated with wound complications due to limited soft tissue coverage. A 56-year-old man presented with a progressively enlarging, painful mass over the lateral malleolus of the left ankle, causing difficulty wearing shoes. Imaging studies revealed a periarticular soft tissue mass with calcification and rice body-like inflammatory changes. Despite imaging findings suggestive of joint involvement, the lesion was clinically localized extra-articularly. Endoscopic excision was performed by directly inserting a trocar into the tophaceous mass to create a working tunnel, without introducing an arthroscope into the ankle joint. Extensive chalky deposits were successfully removed with minimal soft tissue disruption. Extra-articular endoscopic excision is a safe and effective minimally invasive option for treating lateral malleolar gouty tophi. This approach may obviate the need for intra-articular arthroscopy, even when periarticular inflammatory changes are present on imaging, and can provide favorable functional outcomes with reduced risk of wound complications.