A 73-year-old man presented with nontraumatic debilitating anterior left knee pain. Magnetic resonance imaging suggested a partial patellar tendon tear. However, ultrasound imaging revealed multiple small hyperechoic areas with posterior acoustic shadowing with intermixed hypoechoic fluid within the proximal patellar tendon, consistent with gouty tophi. The patient underwent ultrasound-guided needle barbotage of the tophi. Gout was confirmed by the presence of uric acid crystals in the aspirate. He had immediate pain relief. Ultrasound imaging 6 weeks later demonstrated healing of the tendon without tophi recurrence. At 6-month follow-up, the patient remained asymptomatic. This case highlights a rare cause of knee pain, promotes diagnostic ultrasound, and describes a novel treatment technique for intratendinous tophaceous gout.
Level of evidence: V.
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