calcium pyrophosphate crystals in synovial fluid

#Calcium pyrophosphate crystals in synovial fluid full

Symptoms of acute pseudogout are similar to that of septic arthritis 1), which poses diagnostic difficulties. It has been proposed that the mechanism for this is either that the crystals are liberated or 'shed' from preformed deposits within the joint or alternatively that an intra-articular insult may trigger their formation 2 5). Secondary deposits are more likely to occur in the presence of degenerative knee changes as a result of trauma and surgery 2). Primary deposits are thought to be due to a metabolic cause, such as hyperparathyroidism and haemochromatosis where crystallization occurs within the synovial fluid 2 5 6). Several causes of CPPD deposition have been proposed, with its occurrence being classified as either primary (non-traumatic) or secondary (traumatic). It usually presents in one or multiple large joints, with severe joint pain, redness and swelling due to effusion 1 2 3 4). Pseudogout is characterised by the deposition of CPPD crystals in the synovial fluid or menisci. In our case, the knee was washed out and the synovial fluid was positive for pseudogout crystals. 3).Īcute onset of pain following an ACL reconstruction can raise the possibility of infective arthritis. A further arthroscopy at that time was performed to debride the knee and alleviate the pain, which showed the graft had incorporated well but degenerative changes had progressed to involve both the lateral and patellofemoral compartments ( Fig. One year later, he presented with continuing pain in the knee.

#Calcium pyrophosphate crystals in synovial fluid full

Unfortunately, he did not follow the full postoperative physiotherapy rehabilitation and did not attend clinic appointments. He was treated with non-steroidal anti-inflammatory drugs (Diclofenac) and his pain improved. The fluid was obtained at the time of washout, as given the amount of swelling and raised inflammatory markers, it was considered more appropriate to improve the patient's symptoms even if the diagnosis proved not to be septic arthritis. The synovial fluid was straw-colored and grew no organisms or culture but was positive for calcium pyrophosphate crystals on microscopic examination. He had no new arthroscopic findings in terms of degenerative changes. 2), and there was no chondrocalcinosis of the menisci. He underwent an arthroscopic joint washout of the knee. Although he was apyrexial, the inflammatory markers were raised, with the erythrocyte sedimentation rate and C-reactive protein levels at 110 mm/hr (normal range, 1 to 7 mm/hr) and 130 mg/L (normal range, 0.1 to 6 mg/L), respectively. Plain radiographs showed no chondrocalcinosis. The arthroscopic portals were well healed. He had a limited range of movement with only 10°-90° of knee flexion further movements were restricted by pain. Clinically, he had a severe effusion in the knee, but he was able to bear weight with some discomfort. He did not report any locking or giving way, or a new injury. He responded well initially and underwent a physiotherapy rehabilitation program.Īt six weeks after surgery, he presented with a two-day history of pain and swelling in the knee. The medial meniscus showed evidence of previous partial meniscectomy that had been performed six years previously. At arthroscopy, he was found to have degenerative chondral changes in the lateral compartment, mainly on the tibial side. Magnetic resonance imaging scan showed moderate osteoarthritic changes and a subchondral cyst in the central portion of the lateral femoral condyle ( Fig. The common features, presentation and diagnostic difficulties are discussed.Ī 35-year-old man underwent ACL reconstruction of the right knee with hamstring tendons and partial lateral meniscectomy for a meniscal tear. We present a report of a rare case of pseudogout attack in a patient after anterior cruciate ligament (ACL) reconstruction. In a postoperative patient, the presentation of an attack of pseudogout can be identical to that of a septic arthritis 1).

Pseudogout classically presents with symptoms of acute or chronic inflammation of a joint 3), but patients can often be asymptomatic 1). Calcification of cartilage in the knee is the most common finding as a result of CPPD deposition 2). Pseudogout is a condition where crystals of calcium pyrophosphate dihydrate (CPPD) are deposited within a joint 1).