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


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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.

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Partial Rotator Cuff Tears: a review of the literature

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:30-34 | Stefania Kokkineli, Emmanouil Brilakis, Emmanouil Antonogiannakis

Author: Stefania Kokkineli [1], Emmanouil Brilakis [1], Emmanouil Antonogiannakis [1]

[1] Department of Orthopaedic, HYGEIA Hospital. MD. Erythrou Stavrou 4, Marousi 15123

Address of Correspondence
Dr. Stefania Kokkineli,
Department of Orthopaedic, HYGEIA Hospital. Athens, Greece
Address: Erythrou Stavrou 4, Marousi 15123. Greece


Partial- thickness rotator cuff tears are the most common cause of shoulder pain in adults and have been classified into subtypes according to location and depth. The frequency rate and tear size progression increase with age, tobacco use and medical comorbidities. Partial tears are divided into tears of acute, chronic or acute-on-chronic onset. Surgical treatment is indicated in symptomatic patients with persistent pain after failed conservative treatment of at least 3 months, mainly with tears that exceed 50% of the tendon thickness. Arthroscopic repair techniques include in situ and tear completion repair. Authors’ preferred technique for in situ repair is described followed by the postoperative rehabilitation protocol. The surgical techniques described have various advantages and disadvantages with regard to intra- operative complications, clinical outcomes, recovery time and re-tear rates which make it difficult to decide on which technique to use. The option is a matter of surgical indications, philosophy and skills.
Keywords: Partial-thickness rotator cuff tears, transtendon repair, in-situ repair, shoulder, arthroscopy


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14. Habermeyer, P., Krieter, C., Tang, K., Lichtenberg, S., Magosch, P. A new arthroscopic classification of articular-sided supraspinatus footprint lesions: A prospective comparison with Snyder’s and Ellman’s classification. JSES. 2008;17(6):909–913. doi:10.1016/j.jse.2008.06.007.
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16. Dow, D. F., Mehta, K., Xu, Y., England, E. The Relationship Between Body Mass Index and Fatty Infiltration in the Shoulder Musculature. J Comput Assist Tomogr. 2018;42(2):323-329. doi:10.1097/rct.0000000000000672.
17. Yamamoto, N., Mineta, M., Kawakami, J., Sano, H., Itoi, E. Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders. Am J Sports Med. 2017;45(11):2524–2531. doi:10.1177/0363546517709780.
18. Ranebo, M., C., Björnsson Hallgren, H., C., Adolfsson, L., E. Patients with a long-standing cuff tear in one shoulder have high rates of contralateral cuff tears: a study of patients with arthroscopically verified cuff tears 22 years ago. JSES. 2018;27(3):e68–e74. doi:10.1016/j.jse.2017.10.007.
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20. Gereli, A., Kocaoglu, B., Ulku, T. K., Silay, S., Kilinc, E., Uslu, S., Nalbantoglu, U. Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2498–2504. doi:10.1007/s00167-018-4870-1.
21. Hahn, S., Lee, Y., H., Chun, Y., M., Park, E., H., Suh, J., S. Magnetic resonance arthrography results that indicate surgical treatment for partial articular-sided supraspinatus tendon avulsion: a retrospective study in a tertiary center. Acta Radiologica. 2017;58(9), 1115–1124. doi:10.1177/0284185116684673.
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28. Shin SJ, Jeong JH, Jeon YS, Kim RG. Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique. Arch Orthop Trauma Surg. 2016;136(12):1701–1708. doi:10.1007/s00402-016-2546-1.
29. Zafra M, Uceda P, Muñoz-Luna F, Muñoz-López RC, Font P. Arthroscopic repair of partial-thickness articular surface rotator cuff tears: single-row transtendon technique versus double-row suture bridge (transosseous equivalent) fixation: results from a prospective randomized study. Arch Orthop Trauma Surg. 2020;10.1007/s00402-020-03387-6.
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31. Osti, L., Buda, M., Andreotti, M., Osti, R., Massari, L., Maffulli, N. Transtendon repair in partial articular supraspinatus tendon tear. Br Med Bull. 2017;123(1):19–34. doi:10.1093/bmb/ldx023.
32. Heuberer, P., R., Smolen, D., Pauzenberger, L., Plachel, F., Salem, S., Laky, B., et al. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity. The Am J Sports Med.2017;45(6):1283–1288. doi:10.1177/0363546517689873..

How to Cite this article: Kokkineli S, Brilakis E, Antonogiannakis E. Partial Rotator Cuff Tears: a review of the literature. Journal of Clinical Orthopaedics July-Dec 2020;5(2):30-34.

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Posterior shoulder instability

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 31-35 | E. Taverna, A.Spreafico, C. Perfetti, V. Guarrella

Author: E. Taverna [1], A.Spreafico [1,2], C. Perfetti [1], V. Guarrella [1]

[1] IRCCS Istituto ortopedico Galeazzi, Milan, Italy
[2] Università degli studi di Milano, Scuola di specializzazione in Ortopedia e Traumatologia

Address of Correspondence
Dr. E. Taverna,
IRCCS Istituto ortopedico Galeazzi, Milan, Italy


Normally, shoulder movements are well balanced through an interplay between static structures (bone and soft tissues as capsule, ligaments and labrum) and muscular dynamic stabilizers (muscles and tendons). Dysfunction of one or more of these components due to an injury, degeneration or congenital abnormalities may lead to shoulder instability with concomitant pain and dysfunction. This article provides an overview of the soft tissue and bony anatomy of the shoulder joint and pathopysiology of shoulder instability. It also covers the important aspects of clinical examination and special test for diagnosis of shoulder instability. A brief over view of conservative and surgical management protocols for shoulder instability are also covered in view of recent literature and authors experience.
Keywords: Posterior shoulder instability, conservative treament, Surgical management, arthroscopy.


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How to Cite this article: Taverna E, Spreafico A, Perfetti C, Guarrella V. Posterior shoulder instability. Journal of Clinical Orthopaedics Jan-June 2020;5(1):31-35.

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