Osteochondral lesion of talus with gout tophi deposition: A case report

Abstract

BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. It arises from diverse causes, and although trauma is implicated in many cases, it does not account for the etiology of every lesion. Gout is a chronic arthritic disease caused by excess levels of uric acid in blood. Intraosseous deposition of monosodium urate in the clavicle, femur, patella and calcaneus was reported previously. Gout is common disease but rare at a young age, especially during teenage years. Osteochondral lesion caused by intra-articular gouty invasion is very rare. CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus (OLT) with gout. He had fluctuating pain for more than 2 years. We could see intra-articular tophi with magnetic resonance image (MRI) and arthroscopy. We performed arthroscopic exploration, debridement and microfracture. Symptoms were resolved after operation, and bony coverage at the lesion was seen on postoperative images. We had checked image and uric acid levels for 18 mo. CONCLUSION It is rare to see OLT with gouty tophi in young adults. While it is challenging, the accuracy of diagnosis can be improved through history taking, MRI and arthroscopy.

Gouty tophus as a rare cause of a Hepple stage V osteochondral lesion of the talus

“…In the literature, we found a similar report on gout tophus as an unusual cause of talus fracture, but this was a 41-yearold man with a 20-year history of untreated gout, and pathological talus fracture-like neoplastic bone destruction was also reported [9], whereas in the present case the cyst lesion was well defined. We also found a remarkably similar report on gout tophus as an unusual cause of talus osteochondral lesion in a 16-year-old male who complained of fluctuating ankle pain on the anteromedial side, which was successfully managed with arthroscopic debridement and microfracture [10]. In the present case, osteochondral autologous transplantation was employed mainly due to the relatively larger lesion size.…”

Arthroscopic surgery for ankle gouty arthritis: a retrospective analysis of clinical outcomes at six month follow-up based on a novel classification system

“…Osteochondral lesions of the talus (OLT) are typically ascribed to either traumatic or haematologic origins, whereas gout-induced OLT is extremely rare [ 24 ]. Both Taeho and Tao have each reported a case of a male adolescent presenting with an OLT bone cyst accompanied by MSU crystal deposition [ 25 , 26 ]. Interestingly, neither patient had a history of trauma to the foot or ankle, and both bone cysts were situated medially to the talus.…”

Correlations of characteristics with tissue involvement in knee gouty arthritis: Magnetic resonance imaging analysis

“…In a comparative study of diagnostic performance for KGA, arthroscopic examination demonstrated a sensitivity of 88.68 % and a specificity of 82.35 % [ 16 ]. Minimally invasive arthroscopy, compared to ultrasound, DECT, and MRI, shows superior diagnostic performance for KGA [ [16] , [17] , [18] ]. It can sensitively detect MSU crystals, provide comprehensive observations within the knee joint, and accurately assess the severity of MSU crystal deposition and tissue involvement.…”