Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2015 Aug;50(4):337-341. Korean.
    Published online Aug 24, 2015.
    https://doi.org/10.4055/jkoa.2015.50.4.337
    Copyright © 2015 by The Korean Orthopaedic Association
    Case Report

    An Intratendinous Tophaceous Gout Mistaken for Cellulitis in the Patellar Tendon

    Se-Hyuk Im, M.D., Bo-Kyu Yang, M.D., Seok-Woo Nam, M.D., Hyun-Seok Chung, M.D., Seung-Rim Yi, M.D., Young-Joon Ahn, M.D., Seong-Wan Kim, M.D. and Ye-Hyun Lee, M.D.
      • Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea.
    • Correspondence to: Bo-Kyu Yang, M.D. Department of Orthopaedic Surgery, National Police Hospital, 123 Songi-ro, Songpa-gu, Seoul 05715, Korea. TEL: +82-2-449-2120, FAX: +82-2-3400-1247, Email: jdoc3846@google.com
    Received August 29, 2014; Revised October 28, 2014; Accepted December 22, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Gout is characterized by recurrent attacks of arthralgia, and deposition of monosodium urate crystals in and around the joints of the extremities and soft tissues. Monosodium urate crystals are observed most frequently at the 1st metatarsophalangeal joint and usually presented in the ankle and wrist joint. However, no case of an intratendinous tophus in the patellar tendon has been reported in Korean literature. In this report, we found monosodium urate crystals in the patellar tendon on magnetic resonance imaging images and intratendinous tophus were visible to the naked eye by excision. We reported on the case of a patient who experienced an unusual intratendinous tophus in the patellar tendon.

    Keywords
    patellar tendon; gout

    Figures

    Figure 1
    Knee joint anterioposterior view (A) and knee joint lateral view (B) shows no definite findings.

    Figure 2
    (A) T1-weighted spiral sagittal enhancement magnetic resonance imaging (MRI) shows edematous change from the prepatellar area to the pretibial area and rim enhancement at the infrapatellar fat pad area. (B) T1-weighted axial enhancement MRI shows fluid collection and peripheral rim enhancement in the middle of the patellar and retro-patellar tendon area.

    Figure 3
    (A) T2-weighted sagittal magnetic resonance imaging (MRI) shows intratendinous fluid collection along the patellar tendon and infrapatellar fat pad area. (B) T2-weighted axial MRI shows fluid collection in the middle of the patellar and retro-patellar tendon area.

    Figure 4
    (A) Intraoperative photograph shows white caseous materials. (B) Below the white caseous material, yellowish fluid collection was found.

    Figure 5
    Chalky white mass was found after dissection.

    Notes

    CONFLICTS OF INTEREST:The authors have nothing to disclose

    References

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    MeSH Terms
    Ankle
    Arthralgia
    Cellulitis*
    Extremities
    Gout*
    Humans
    Joints
    Magnetic Resonance Imaging
    Metatarsophalangeal Joint
    Patellar Ligament*
    Uric Acid
    Wrist Joint
    Metrics
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