Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3814-3820
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3814
Osteochondral lesion of talus with gout tophi deposition: A case report
Taeho Kim, Young-Rak Choi
Taeho Kim, Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Gyeonggi-do, South Korea
Young-Rak Choi, Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Choi YR was the patient’s orthopaedic surgeon, reviewed the literature and contributed to manuscript drafting; Kim TH reviewed the literature and contributed to manuscript drafting and analyzed and interpreted the imaging findings; all authors issued final approval for the version to be submitted.
Supported by (partially) the Korea Health Technology R&D Project through the National Research Foundation of Korea (NRF) grant funded by the Korea government, No. NRF-2017R1C1B5017705.
Informed consent statement: Written informed consent was obtained from the patient’s mother for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Young-Rak Choi, MD, Associate Professor, Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. jeanguy@hanmail.net
Received: May 7, 2020
Peer-review started: May 7, 2020
First decision: May 15, 2020
Revised: May 27, 2020
Accepted: August 12, 2020
Article in press: August 12, 2020
Published online: September 6, 2020
Processing time: 119 Days and 20.2 Hours
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.

Keywords: Ankle; Gout; Osteochondral lesion of the talus; Tophi; Magnetic resonance image; Arthroscope; Case report

Core tip: Osteochondral lesion of talus (OLT) is usually known as a posttraumatic or repetitive stress lesion. It is rare to see OLT caused by gout tophi deposition. Furthermore, it is extremely rare in young adult or the adolescent. This case highlights the thorough history taking, radiologic study and arthroscopic finding for diagnosis.