What Causes Sinding Larsen Johansson Syndrome?

Sinding Larsen Johansson Syndrome is a juvenile osteochondrosis that disturbs the patella tendon attachment to the inferior pole of the patella.

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.

What Causes Sinding Larsen Johansson Syndrome?

In the skeletally immature or adolescent athlete, Sinding-Larsen-Johansson syndrome most likely results from a traction injury of the knee extensor mechanism at the junction of the patellar ligament and the inferior pole of the patella. This juvenile traction osteochondrosis is similar to Osgood-Schlatter syndrome.

Strong repetitive quadriceps contractions are thought to cause a traction force on the inferior pole, disrupting the immature bone. There is a higher incidence in active children during the adolescent growth spurt.

As a child grows, bones go through different stages of development.

1. The patella pole is initially cartilaginous (cartilaginous stage). 
2. It then enters the apophyseal stage when the secondary ossification centre (apophysis) appears.
3. The unity of the proximal tibial epiphysis with the tibial apophysis marks the epiphyseal stage.
4. Lastly, when the growth plates fuse, the bony stage has been reached.

Children are most susceptible to Sinding-Larsen-Johansson syndrome when their bones are in the (2nd) apophyseal stage. During this phase the apophysis is unable to withstand high tensile forces. When presented with strong, repetitive muscle contractions, micro-fractures occur at the immature area. 

A potential cause for Sinding-Larsen-Johansson syndrome may be the lack of growth of the quadriceps in comparison to the femur. During a growth spurt in a child, the lengthening of the muscle is unable to keep up with the lengthening of the rapidly lengthening femur, resulting in increased tensile force on the patella.

Sinding-Larsen-Johansson Syndrome is more likely in active children who participate in sports that involve running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics.

What the Symptoms of Sinding Larsen Johansson Syndrome?

Localised pain, swelling or tenderness is felt at the front of your knee - at the base of your patella (kneecap), where the patella tendon inserts into the patella.

Patients are typically active boys aged 10 to 13 years but can also affect active girls a couple of years younger. Symptoms are usually:

• Worse with exercise, stair climbing, squatting, kneeling, jumping and running.
• Cause you to limp after exercise (as the condition progresses).
• May be unilateral or bilateral.
• Is relieved by rest

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.

How is Sinding Larsen Johansson Syndrome Diagnosed?

Sinding Larsen Johansson Syndrome is normally diagnosed clinically by your physiotherapist or doctor. Knee X-ray can show calcification or ossification at the junction between the patella and the patella ligament. MRI scan will exclude most other musculoskeletal injuries.

Treatment for Sinding Larsen Johansson Syndrome

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