Intratendinous Tophaceous Gout Imitating Patellar Tendonitis in an Athletic Man

Abstract

Patellar tendon-related pain is common in the athletic patient. When it occurs in skeletally mature patients participating in running, jumping, or kicking sports, the diagnosis of jumper’s knee patellar tendonitis is usually made. If patellar tendon pain is associated with a mass, the differential diagnosis should be broadened to include crystalline arthropathy. This article presents a case of a highly athletic 45-year-old man with a history of gout, anterior knee pain, and an enlarging mass in the region of the patellar tendon. Conservative management failed, and an excisional biopsy found it to be an intra-tendinous gouty tophus. To our knowledge, only 1 report exists documenting a patellar tendon mass secondary to gout, and no case report exists documenting this problem in an athlete. The interplay between athletics and gout has not been well described. Despite the long-term protective nature of fitness, transient elevations in uric acid associated with athletic endeavors may contribute acutely to manifestations of gout in some athletes. Resultant intra- or extra-articular pathology may present as, and easily be mistaken for, a sports-related injury. Without appropriate medical management, tophaceous deposition may continue to occur and treatment of the resultant mass may require surgical intervention.

The Gouty Tophus: a Review

“…In addition, there have been recent reports of unusual sites or presentations of tophaceous disease. This includes atypical musculoskeletal presentations causing spinal cord or nerve root compression [16][17][18] or involving the tarsal tunnel [19], the patellar tendon [20,21], the second metacarpal [22] and the os trigonum [23]. Additionally, non-skeletal presentations may rarely occur, including in the bronchus, causing airways obstruction [24], the mitral valve [25], the liver [26] and the breast [27].…”

Diagnosis and Treatment of Gouty Tophi in the Patellar Tendon Using Ultrasound‐Guided Needle Barbotage: A Case Presentation

“…The first case was a 69‐year‐old man with a 20‐year history of gout in multiple locations, including the knee joint and the distal patellar tendon, as evidenced by DECT but not in plain radiographs [2]. The second case was a 45‐year‐old man with a 2‐year history of gout who was very active, misdiagnosed with patellar tendonitis, and later confirmed to have intratendinous gout by DECT [3]. The third case was a 42‐year‐old male triathlete with a family history of gout, who was diagnosed with patellar tendonitis on MRI and later diagnosed with gout after visualization of tophi on ultrasound imaging, confirmed on microscopic examination [4].…”

Diagnostic Imaging and Management of Common Intra-articular and Peri-articular Soft Tissue Tumors and Tumorlike Conditions of the Knee

“…Histological examination is consistent with granulomatous inflammation associated with crystalline material and positive for urate crystals. 5 Treatment of gout flares is primarily medical and involves the use of nonsteroidal anti-inflammatory drugs, colchicine, allopurinol, and other uricosurics. Although most gouty tophi are without symptoms and can easily be observed, surgical treatment may be indicated in patients with loss of function, severe disability, or persistent pain in spite of medical treatments that have minimal effect on tophaceous deposits.…”