Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report

Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 42-44 | Febyan, I Gusti Ngurah Paramartha Wijaya Putra, Made Deker, Agus Eka Wiradiputra

Author: Febyan [1], I Gusti Ngurah Paramartha Wijaya Putra [1], Made Deker [1], Agus Eka Wiradiputra [1]

[1] Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia

Address of Correspondence
Dr. Febyan,
Department of Orthopaedics & Traumatology, Bhayangkara Denpasar Hospital, Bali, Indonesia


Gout is an inflammatory disease commonly characterized by tophus deposits containing uric acid crystals in the intraarticular joints. An acute locked joint due to gouty tophus formation is a rare finding. This case describes a 36-year-old man with sudden pain and locking in the knee joint. Physical examination, plain radiography, and serum uric acid examination showed unremarkable results. Further investigation with diagnostic arthroscopy confirmed tophaceous gout as the sole cause of an acutely locked knee. The patient exhibited satisfactory clinical results following surgical intervention under arthroscopy and the administration of urate-lowering agents. This case highlights the probability of tophus deposition as the cause of an acute locked knee, despite unremarkable initial presentation. The awareness regarding this case should be raised, especially on emphasizing arthroscopy as a cost-effective diagnostic and therapeutic modality in patient management.

Keywords: Arthroscopy, gouty tophi, knee joint, rare case


1. Ozturk R, Atalay IB, Bulut EK, Beltir G, Yilmaz S, Gungor BS. Place of orthopedic surgery in gout. Eur J Rheumatol 2019;6(4):212-5.
2. Dehlin M, Drivelegka P, Sigurdardottir V, Svärd A, Jacobsson LT. Incidence and prevalence of gout in Western Sweden. Arthritis Res Ther 2016;18:164.
3. Mohd A, Gupta Ed, Loh Y, Gandhi C, D’Souza B, Gun S. Clinical characteristics of gout: a hospital case series. Malays Fam Physician 2011;6(2-3):72-3.
4. Amber H. Singh VA, Azura M. Gouty tophi mimicking synovial sarcoma of the knee joint. Arch of Rheumatol 2012;27(3):208-11.
5. Ashar NAK, Hussin P, Nasir MNM, Mawardi M. Degenerative osteophyte causing acute locked knee in a young man: a case report. Malays J Med Sci 2019;15(3):161-3. .
6. Bansal P, Deehan DJ, Gregory RJH. Diagnosing the acutely locked knee. Injury 2002;33(6):495-8.
7. Hwang HJ, Lee SH, Han SB, Park SY, Jeong WK, Kim CH, et al. Anterior cruciate ligament rupture in gouty arthritis. Knee Surg Sports Traumatol Arthrosc 2012;20(8):1540-2.
8. Wong JK, Chan WH. Giant cell tumor of the tendon sheath arising from anterior cruciate ligament. New Horiz Clin Case Rep 2017;2:31.
9. Chatterjee S, Ilaslan H. Painful knee locking caused by gouty tophi successfully treated with allopurinol. Nat Clin Pract Rheumatol 2008;4(12):675-9.
10. Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective – Areview. J Adv Res 2017;8(5):495-511.
11. McQueen FM, Chhana A, Dalbeth N. Mechanisms of joint damage in gout: evidence from cellular and imaging studies. Nat Rev Rheumatol 2012;8(3):173-81.
11. Melloni P, Valls R, Yuguero M, Sáez A. An unusual case of tophaceous gout involving the anterior cruciate ligament. Arthroscopy 2004;20(9):e117-21.
13. Ko KH, Hsu YC, Lee HS, Lee CH, Huang GS. Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. J Clin Rheumatol 2010;16(5):209-14.
14. Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol 1980;134(4):781-7.
15. Pan F, Li Q, Tang X, Xue J, Li J. Method and effectiveness of arthroscopic debridement for treating gouty arthritis of the knee. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi (Chinese Journal of Reparative and Reconstructive Surgery)
2011;25(8):937-40 (in Chinese).
16. Patel UJ, Freetly TJ, Yueh J, Campbell C, Kelly MA. Chronic tophaceous gout presenting as bilateral knee masses in an adult patient: a case report. J Orthop Case Rep 2019;9(5):16-9.

How to Cite this article: Febyan, Putra IGNPW, Deker M, Wiradiputra AE. Unusual Finding of Gouty Tophus in Adult Male with Acute Locked Knee: A Rare Case Report. Journal of Clinical Orthopaedics Jul-Dec 2021;6(2):42-44.

 (Abstract    Full Text HTML)   (Download PDF)