No effusion or subcutaneous tophi could be seen. Tenderness over the medial and lateral retinacula and positive medial patellar plica stutter test were also noted. At presentation the significant physical findings of the left knee included limited ROM between 10° and 100° due to severe pain as well as positive Watson-Jones test and patellofemoral compression grinding and gliding tests. He did not recall any knee trauma that predated the initial knee symptoms. Thereafter, he ignored his treatment for 1 more month. After 1-month medication for acute gout attack, serum urate level had returned within normal limits (5.9 mg/dl), but the result had not been satisfactory due to persistent pain with limitation of knee ROM. He had had gouty arthritis without regular treatment for 13 years. We describe a rare case of arthroscopically successful treatment for gouty tophi presenting as medial patellar plica syndrome and patellofemoral disorder causing longterm mechanical problems.Ī 45-year-old male laborer complained of left anterior knee pain for 3 months with gradually limited ROM. With improved medical management over the past decade, tophi deposition usually lacks obvious symptoms and seldom needs surgical intervention in the knee joint 2– 5. Mechanically limiting the range of motion (ROM) of the knee joint is a rare occurrence in patients with chronic gout, which is associated with the appearance of multiple periarticular gouty tophi 1 and a symptomatic tophus in the knee joint 2– 5.
For anterior knee pain, an accurate history and examination confirming the diagnosis is most important to avoid unsuitable treatment. Even medial patellar pain is more likely to be associated with patellofemoral maltracking than medial patellar plica syndrome. Patellofemoral disorders are the most important causes of anterior knee pain and can be treated by conservative methods, arthroscopic lateral retinacular release, and proximal and distal realignment procedures.
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