0:00

<v ->So, this is another case.

0:03

We have the MRI showing this is a younger patient actually.

0:07

This patient is a six-year-old female.

0:11

We can see signs of OA here, okay?

0:15

Especially on the femoral, medial femoral tibial.

0:21

Cartilage, osteophytes.

0:22

Meniscal is small and irregular, okay?

0:29

We see some cysts,

0:30

but what is calling the attention on this patient here?

0:34

We have a joint fusion.

0:38

Again, the ACL is,

0:42

with the signal alteration, is thick,

0:45

has signal alteration,

0:48

and also has a communication with this cyst here.

0:52

See, the cyst, the bone cysts, are

0:57

adjacent to the ACL insertion here.

1:00

So, when we see that kind of ACL,

1:04

we also wanna know

1:06

if there is any rheumatologic process going on, okay?

1:11

And then we'll look again for some tips,

1:16

and we can see there is a small erosion here,

1:21

cortical at the popliteus insertion,

1:23

and the popliteus tendon is large with signal alteration.

1:28

And this raises the possibility

1:32

that we are dealing again with gout and a secondary OA.

1:38

So we have OA, we have ACL abnormalities,

1:43

cysts, and a popliteus tendon.

1:47

Look at this insertion here.

1:49

And we have an X-ray showing

1:53

some tips that may help.

1:56

Okay? May help.

1:58

See, the knee with the problem,

2:03

the right knee.

2:03

We can see some calcifications here.

2:07

They are not typical for CPPD.

2:10

The calcification we are seeing here,

2:13

they can be found in gout because they are more cloudlike

2:18

and they get the capsule also.

2:21

So this

2:25

was the differential,

2:28

and we also mentioned, maybe a pyrophosphate

2:34

or gout associated with secondary OA.

2:38

So they will analyze the synovial fluid.

2:43

They will check for the urate blood

2:47

to see if it's increased or not.

2:49

But this is probably a case of the secondary OA

2:55

by a metabolic crystal deposition disease.

2:59

<v ->Yeah, that's interesting.

3:00

And it points out, again, those target sites

3:02

of the cruciate and the popliteus tendon in gout.