Pseudogout: A Rare Cause of Acute Arthritis Following Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

We report a case of an acute pseudogout attack following single-bundle anterior cruciate ligament (ACL) reconstruction in a 35-year-old man. At the initial reconstruction surgery, he was found to have early degenerative changes mainly in the lateral compartment. He presented with acute onset pain and swelling following reconstruction of the ACL. Arthroscopic irrigation was performed and the synovial fluid was positive for calcium pyrophosphate crystals. A pseudogout attack must be considered in the differential diagnosis in cases of acute onset pain and swelling after arthroscopic surgery, especially with the background of degenerative knee changes, and this may signify a poorer long-term outcome.

Keywords: Anterior cruciate ligament; Arthritis; Knee; Pseudogout; Reconstruction.

Fig. 1. Coronal magnetic resonance imaging scan of the knee showing abnormal bone in the lateral femoral condyle and the adjacent tibial plateau.

Fig. 2. Arthroscopic image obtained during knee washout after anterior cruciate ligament reconstruction showing the intact graft.

Fig. 3. Arthroscopic images obtained one year after anterior cruciate ligament (ACL) reconstruction showing the ACL graft fully incorporated and intact, and extensive cartilage loss over the trochlear region.