---
title: "Gout Presenting as Late-Onset Achilles Tendinopathy After Repair: Clinical Case Series"
id: "pubmed-42885909"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42885909"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42885909/"
doi: "10.1097/CORR.0000000000004167"
published_at: "2026-10-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Gout Presenting as Late-Onset Achilles Tendinopathy After Repair: Clinical Case Series
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42885909
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42885909/)
- **DOI:** [10.1097/CORR.0000000000004167](https://doi.org/10.1097%2FCORR.0000000000004167)
- **Published At:** 2026-10-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The report describes 4 adult male patients, aged 42–55, who developed acute atraumatic **Achilles tendon**–region inflammation 2 to 18 years after open repair. - Presentations included pain, swelling, erythema, drainage, fluctuance, or induration; the treating surgeons initially suspected infection in all cases. - Three patients underwent aspiration and/or surgical irrigation and debridement for presumed infection; one was managed nonoperatively for suspected gout. - In the three surgically treated patients, clinicians observed chalky, tophaceous material adjacent to the tendon; bacterial cultures were negative. - Pathology in those three surgical cases confirmed **monosodium urate** crystals, establishing gout rather than bacterial infection. - The nonsurgical patient had hyperuricemia and improved with medical management, but had no pathological confirmation of gout. - All four patients reported symptom resolution at latest follow-up (6–16 months). - The authors noted that serum uric acid can be normal during such presentations; absence of systemic sepsis signs should prompt consideration of gout. - The series is descriptive (Level IV); the authors reported no denominator for total Achilles repairs by the contributing surgeons and acknowledged a small sample size and limited generalizability. - The study team recommended routine crystal analysis when aspirate or surgically obtained material is available to reduce unnecessary debridement or prolonged empiric antibiotics when infection is not otherwise supported.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Gout May Mimic Infection, Even Years After Achilles Tendon Repair [Tyler D DeSena](https://pubmed.ncbi.nlm.nih.gov/?term=DeSena+TD&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Paul H Fine-Lease](https://pubmed.ncbi.nlm.nih.gov/?term=Fine-Lease+PH&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Jason L Hornick](https://pubmed.ncbi.nlm.nih.gov/?term=Hornick+JL&cauthor_id=42885909)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-2 "Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA."), [Emily B Parker](https://pubmed.ncbi.nlm.nih.gov/?term=Parker+EB&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Giovanna Kalin](https://pubmed.ncbi.nlm.nih.gov/?term=Kalin+G&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Sheldon S Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+SS&cauthor_id=42885909)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-3 "Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA."), [Jason T Bariteau](https://pubmed.ncbi.nlm.nih.gov/?term=Bariteau+JT&cauthor_id=42885909)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-4 "Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA."), [Christopher P Chiodo](https://pubmed.ncbi.nlm.nih.gov/?term=Chiodo+CP&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#full-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA.") Affiliations Expand ### Affiliations * 1 Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA. * 2 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. * 3 Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA. * 4 Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA. * PMID: **42885909** * DOI: [ 10.1097/CORR.0000000000004167 ](https://doi.org/10.1097/corr.0000000000004167) Item in Clipboard # Gout May Mimic Infection, Even Years After Achilles Tendon Repair Tyler D DeSena et al. Clin Orthop Relat Res. 2026. Show details Display options Display options Format Abstract PubMed PMID Clin Orthop Relat Res Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Clin+Orthop+Relat+Res%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Clin+Orthop+Relat+Res%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42885909/) . 2026 Oct 16. doi: 10.1097/CORR.0000000000004167. Online ahead of print. ### Authors [Tyler D DeSena](https://pubmed.ncbi.nlm.nih.gov/?term=DeSena+TD&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Paul H Fine-Lease](https://pubmed.ncbi.nlm.nih.gov/?term=Fine-Lease+PH&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Jason L Hornick](https://pubmed.ncbi.nlm.nih.gov/?term=Hornick+JL&cauthor_id=42885909)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-2 "Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA."), [Emily B Parker](https://pubmed.ncbi.nlm.nih.gov/?term=Parker+EB&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Giovanna Kalin](https://pubmed.ncbi.nlm.nih.gov/?term=Kalin+G&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA."), [Sheldon S Lin](https://pubmed.ncbi.nlm.nih.gov/?term=Lin+SS&cauthor_id=42885909)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-3 "Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA."), [Jason T Bariteau](https://pubmed.ncbi.nlm.nih.gov/?term=Bariteau+JT&cauthor_id=42885909)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-4 "Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA."), [Christopher P Chiodo](https://pubmed.ncbi.nlm.nih.gov/?term=Chiodo+CP&cauthor_id=42885909)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42885909/#short-view-affiliation-1 "Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA.") ### Affiliations * 1 Department of Orthopaedic Surgery, Foot and Ankle Division, Mass General Brigham, Boston, MA, USA. * 2 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. * 3 Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA. * 4 Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA. * PMID: **42885909** * DOI: [ 10.1097/CORR.0000000000004167 ](https://doi.org/10.1097/corr.0000000000004167) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Gout can affect tendons in addition to joints and may clinically resemble infection. The resulting diagnostic uncertainty may lead to surgical intervention or antibiotic treatment, even in patients whose symptoms might be managed medically if gout is recognized earlier. **Questions/purposes:** (1) Does late-onset gouty Achilles tendinopathy after prior Achilles tendon repair clinically resemble infection? (2) What diagnostic findings, including crystal analysis of aspirate or surgically obtained material when available, helped establish or support gout rather than infection? (3) What were the outcomes after gout was confirmed or suspected? **Methods:** This is a report of 4 patients with a similar presentation. Between April 2021 and June 2024, three surgeons at three academic medical centers identified 4 adult males, aged 42 to 55 years, who developed acute atraumatic Achilles-region pain, swelling, erythema, drainage, fluctuance, or induration 2 to 18 years after open Achilles tendon repair. These presentations raised concern that gout at or near a prior Achilles tendon repair site may mimic infection and lead to unnecessary interventions when gout is not considered early. We do not have an underlying denominator of patients treated for Achilles tendon repair by these surgeons during this period, but we speculate that it is on the order of several hundred. Minimum follow-up was 6 months after the treatment selected for the index Achilles inflammatory presentation. No patients who met these criteria were excluded, and no patients were lost to follow-up before the minimum follow-up interval. To determine whether this presentation clinically resembled infection, we reviewed presenting symptoms and physical examination findings, including pain, swelling, erythema, drainage, fluctuance, induration, fever, constitutional symptoms, and the treating surgeon's initial diagnostic concern. To answer our second question regarding diagnostic findings that established or supported gout rather than infection, we reviewed laboratory studies, imaging, aspiration findings, Gram stain, bacterial cultures, surgical findings, and pathologic evaluation for monosodium urate crystals. To answer our third question regarding outcomes, we reviewed whether patients underwent aspiration, surgical irrigation and debridement, antibiotics, immobilization, antiinflammatory or urate-lowering therapy, rheumatology or infectious disease referral, symptom resolution, recurrence, and complications. Three patients underwent aspiration and/or surgical irrigation and debridement for presumed infection. One patient was treated nonsurgically for suspected gout. **Results:** In 3 of 4 patients, late-onset gouty Achilles tendinopathy after prior Achilles tendon repair clinically resembled infection; it raised concern for an acute inflammatory or infectious process in all 4 patients. Among the 3 patients treated surgically, chalky tophaceous material was identified adjacent to the Achilles tendon, bacterial cultures were negative, and histological analysis confirmed monosodium urate crystals. The fourth patient had suspected gout based on hyperuricemia, Achilles-region symptoms, and improvement with nonsurgical treatment, although gout was not pathologically confirmed. All patients reported symptom resolution by latest follow-up (6 to 16 months). **Conclusion:** Acute gouty tendinopathy can present years after Achilles tendon repair and can closely mimic postoperative infection, even when serum uric acid is normal. In patients without systemic signs of sepsis, earlier consideration of gout and routine crystal analysis when aspirate or surgically obtained material is available may help avoid unnecessary surgical debridement or prolonged empiric antibiotics when infection is not otherwise supported. **Level of evidence:** Level IV, therapeutic study. Copyright © 2026 by the Association of Bone and Joint Surgeons. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. ## References 1. 1. Ahmad MI, Masood S, Furlanetto DM, Nicolaou S. Urate crystals; beyond joints. Front Med (Lausanne). 2021;8:649505. 2. 1. Carr BJ, Ochoa L, Rankin D, Owens BD. Biologic response to orthopedic sutures: a histologic study in a rabbit model. Orthopedics. 2009;32:828. 3. 1. Carroll M, Dalbeth N, Allen B, et al. Ultrasound characteristics of the Achilles tendon in tophaceous gout: a comparison with age- and sex-matched controls. J Rheumatol. 2017;44:1487-1492. 4. 1. Chen BC, Chen SJT, Duchman KR, Sekar P. Extra-articular tophaceous gout of the Achilles tendon mimicking infection. BMJ Case Rep. 2022;15:e247647. 5. 1. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019;71:991-999. 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