What is Sinding-Larsen-Johansson Syndrome?

Sinding-Larsen-Johansson Syndrome (SLJ Syndrome) is named after the doctors who discovered it. Essentially it is a source of knee pain for active children. Sinding-Larsen-Johansson Syndrome is an inflammation of the bone at the bottom of the patella (kneecap), where the tendon from the shin bone (tibia) attaches. It is an overuse knee injury rather than a traumatic injury. While Sinding-Larsen-Johansson Syndrome is a relatively uncommon, it is quite debilitating knee injury that occurs in young active children/adolescents. At PhysioWorks, we see numerous cases every year. Who Suffers Sinding-Larsen-Johansson Syndrome? Sinding-Larsen-Johansson Syndrome usually strikes adolescents who are active during their growth spurts, which is the two year period where they grow most rapidly. Growth spurts can begin anytime between the ages of 8-13 for girls and 10-15 for boys. Sinding-Larsen-Johansson Syndrome is most common in 11 to 14 year olds. Growth spurts make kids vulnerable because their bones, muscles, and tendons are growing quickly and not always at the same time. Sinding-Larsen-Johansson Syndrome is more likely in teens who participate in sports that involve running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics. With increased exercise, the quadriceps muscles and tendon place increased stress on the growth plate at the base of the patella. The growth plate is a layer of cartilage near the end of a bone where most of your bone’s growth occurs. It is weaker and more vulnerable to injury than the rest of the bone during this childhood/adolescent growing phase. What Predisposes You to Sinding-Larsen-Johansson Syndrome? There are several factors which can increase the likelihood of developing Sinding-Larsen-Johansson Syndrome. These need to be identified and corrected where possible, with direction from your physiotherapist to ensure an optimal outcome.  Predisposing causes include: inappropriate or a sudden increase in training or sporting activity lower limb muscle tightness or weakness (particularly the quadriceps) tight lateral retinaculum or patella malalignment poor lower limb biomechanics poor lower limb dynamic stability poor foot posture inappropriate footwear recent growth spurts What the Symptoms of Sinding-Larsen-Johansson Syndrome? Pain, swelling or tenderness is felt at the base of your patella (kneecap), where the patella tendon inserts into the patella. The kneecap pain typically: worsens with exercise causes you to limp after exercise is relieved by rest Investigations While normally unnecessary due to Sinding-Larsen-Johansson Syndrome being readily diagnosed in the clinic you can confirm diagnosis via radiological investigations:  Knee X-ray can show calcification or ossification at the junction between the patella and the patella ligament. MRI scan can be used. What is the Symptom Progression? While a  mild case of Sinding-Larsen-Johansson Syndrome can resolve within a few weeks, severe cases must be professionally managed to avoid growth plate damage. The pain and swelling symptoms can potentially last for years. Longstanding Sinding-Larsen-Johansson Syndrome can result in an avulsion fracture of the patella tendon, which can severely affect your ability to walk or run. Fortunately, Sinding-Larsen-Johansson Syndrome is very successfully managed via physiotherapy. Contact PhysioWorks or Book Online Treatment for Sinding-Larsen-Johansson Syndrome Physiotherapy assessment and treatment is highly recommended in the treatment of Sinding-Larsen-Johansson Syndrome. Most patients with this condition heal extremely well with appropriate physiotherapy. Treatment success is largely dictated by patient compliance.  Differential Diagnosis It is important to ensure that Sinding-Larsen-Johansson Syndrome is the actual diagnosis. Other sources of anterior knee pain require different treatment. A similar but different injury is Osgood Schlatter Disease. Acute Injury Management It is important that the patient rests from any activity that increases their knee pain. Activities placing stress on the patella should be minimised, particularly squatting, sprinting, jumping and hopping.  Ice A combination of ice treatment and a home tens unit will reduce pain and improve the healing rate. This usually hastens the recovery rate of sufferers. Ice is useful at home or after exercise. Rest Rest is also important in the management of Sinding-Larsen-Johansson Syndrome and relief of pain. In mild cases it may enough to just limit the physical activity you do so that the pain is only mild and only lasts for 24-hrs. When symptoms become worse it may be necessary to take a short break from your aggravating sports. Only on rare occasions will a sufferer require crutches. Whether or not you should continue playing sport is dependent on symptoms. Patients with mild symptoms may wish to continue to play some or all sport, others may choose to modify their program. It is best to discuss your exercise workload with your physiotherapist for advice on how to best manage your return sport while respecting your injury. Long-Term Management & Prevention Stretching & Massage One of the common reasons for developing Sinding-Larsen-Johansson Syndrome is excessively tight quadriceps muscles, hamstrings and calves. Your physiotherapist will prescribe specific stretches for you if they assess that you are tight in these muscle groups. Massage is beneficial to reduce chronic tightness in your quadriceps, ITB, hamstrings , adductors or calf muscles. Strengthening Your muscle control around the knee will usually need to be addressed to control or maintain your symptoms during the active phase of Sinding-Larsen-Johansson Syndrome. Your physiotherapist will commonly prescribe or modify exercises for your quadriceps, hamstrings, calves, foot arch muscles and gluteals (buttock muscles). Patella Knee Brace or Taping A specific knee brace that helps to dissipate forces away from the site of Sinding-Larsen-Johansson Syndrome or Kinesiology taping may provide both pain relief and load reduction at the site of pain and injury. Consult with your physiotherapist for the best advice specific to your knee. An example of a Sinding-Larsen-Johansson Syndrome brace. Foot Arch Control & Orthotics Occasionally your foot biomechanics or arch control may be inadequate for your intensity of sport. Your physiotherapist can assist both the assessment and corrective exercises for your dynamic foot control. Active Foot Correction Exercises can be beneficial as both a preventative and corrective strategy. Occasionally, your foot biomechanics may be predisposing you to torsional stresses that can cause abnormal knee forces, which can cause knee injury. In these instances, foot orthotics may need to be prescribed. There are mixed views on how effective these are, since the foot structure is rapidly changing at this age. Ask your physiotherapist or podiatrist for advice. Contact PhysioWorks or Book Online Prognosis Sinding-Larsen-Johansson Syndrome is a self limiting condition that gradually resolves as your skeleton matures. Skeletal maturity usually takes between 6 to 12 months but could persist for as long as two years. With appropriate management, symptoms typically improve gradually over time and full function is restored. In most instances, a physiotherapist-guided rehabilitation and management program for Sinding-Larsen-Johansson Syndrome will have you back to your sport within six weeks. However, as mentioned earlier, your compliance with the program outlined by your physiotherapist is the main factor in a swift, pain-free and successful return to sport outcome. A safe progression back to sports or high-level activities is typically permitted when each of the following happens in this specific order: The lower kneecap is no longer tender and there is no swelling. The injured knee can be fully straightened and bent without pain. The knee and leg have regained normal strength compared to the uninjured knee and leg Ability to jog straight ahead without limping. Ability to sprint straight ahead without limping. Ability to do 45-degree cuts. Ability to do 90-degree cuts. Ability to do 20-metre figure-of-eight runs. Ability to do 10-metre figure-of-eight runs. Ability to jump on both legs without pain  Ability to hop on the injured leg without pain. For your best care and more specific advice please consult with your sports physiotherapist. More Information For a thorough individualised assessment and professionally guided care for your Sinding-Larsen-Johansson Syndrome please consult with your physiotherapist Article by John Miller

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