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needed to understand the pathway of metastasis to IRF. Tophacious gout presenting at the anterior cruciate ligament (ACL) is extremely rare and difficult to differentiate from other intraarticular pathology. This is mainly due to conventional diagnostic tools, such as MRI, producing ambiguous results versus pigmented villonodular synovitis (PVNS) and ganglion cysts. Here we report an individual in their late-20s with a gouty tophus located at the origin of the ACL in the knee. Urate crystals on the articular cartilage in all three compartments was noted as