Two-stage management of uncommon spontaneous rupture of anterior cruciate ligament in knee gouty arthritis: three case reports

<h2>Abstract</h2> Monosodium urate crystal deposition can cause knee gouty arthritis (KGA). However, anterior cruciate ligament (ACL) rupture associated with KGA is rarely reported. We describe three male patients (aged 40–50 years) with 3 months of knee pain and instability, without trauma. Positive Lachman and anterior drawer tests were noted. MRI confirmed ACL rupture. Arthroscopy revealed complete ACL rupture with synovitis and monosodium urate crystals. Reconstructive procedure was delayed for one month while patients received antibiotics, nonsteroid anti-inflammatory drugs, and urate-lowering therapy. Following staged ACL reconstruction, all patients returned to daily activities within 3 months and regained knee stability by 6 months. KGA-associated ACL rupture is uncommon and may be overlooked. For a favorable functional outcome and to avoid complications, arthroscopic debridement and arthroscopic ACLR surgery performed in two stages can be safe and successful; however, caution should be exercised. Sustaining uric acid levels is vital to avert future treatment failure.