Ch Belli, P Bousquet, GP Muller
Papeete – Tahiti
In Polynesia with the rate of gout disease superior to that of the USA (superior by 4% of the population), problems such as intra-articular knee disorders relating to gout are often posed.
The gout causes the weakening of tissues (meniscus, cartilage and ligament) and it is very frequently the origin of mechanical ruptures, therefore the solution doesn’t lie in the administration of medical treatments.
We don’t treat extra articular knee localisations.
After about more than 8000 knee arthroscopy with systematic video recording we have tried to specify the place of arthroscopy in relation with gout disease.
Various stages which are presented:
1. A simple inflammation of the synovial sometimes with a few scattered crystals giving a knee an aspect of angina. This is confirmed by an abnormal uric acid.
2. The uric acid deposits in the thickness of the menisci which is the origin of the ruptures.
3. Cartilage infiltration without breaking
4. Tophus, especially the anterior originating at the bend.
5. Cartilage destruction
We haven’t found an arthroscopic classification of gout.
At first it seems obvious that in the first instance arthroscopy is of no therapeutic value, however its analytical role is serious because this situation can occur with uric acid levels in the upper limit of normal. Therefore justifying the introduction of long-term treatment.
In all other cases we are faced with mechanical lesions which can explain initial symptoms and have an accessible treatment along with appropriate medication. Even in a case of cartilage destruction, arthroscopy keeps everything in place because sometimes it’s the discovery of misplaced tophi which is actually the origin of pain and furthers its arthroscopic resection, the implementation of a suitable drug treatment, and allowing us to significantly reverse the expiry of a prosthetic knee.
The presentation shows these different types of lesions and the treatments which we propose.