Knee

Sinding-Larsen-Johansson Disease

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Sinding-Larsen-Johansson Disease, Sinding-Larsen-Johansson, Larsen-Johansson Disease, Patella Apophysitis, Köhler Patella

  • See Also
  1. Apophysitis
  2. Osgood Schlatter
  3. Pediatric Sports Overuse Injury
  • Pathophysiology
  1. Apophysitis secondary to traction injury at the inferior pole of the Patella
  2. Contrast with Osgood Schlatter which is aphophysitis at the tibial tubercle
  • Epidemiology
  1. Ages 10 to 13 years old
  • Symptoms
  1. Anterior Knee Pain
  2. Worse with jumping or direct pressure on the inferior Patellar pole
  • Signs
  1. Point tenderness at the Patella inferior pole (at junction of Patellar tendon)
  2. Focal swelling may be present
  • Imaging
  1. Knee XRay
    1. Rule-out Fracture, tumor, Patellar sleeve avulsion or ostemyelitis
    2. May demonstrate partial Patellar avulsion with overlying swelling
    3. Abnormal calcification at Ossification Center (at inferior Patellar pole)
  2. Bedside Ultrasound
    1. Fragmentation of the inferior Patella (compared with opposite side)
  • Differential Diagnosis
  1. Osgood-Schlatter (affects tibial tubercle)
  • Management
  1. Relative rest with activity modification
  2. Analgesics (NSAIDs, Acetaminophen)
  3. Ice Therapy
  4. Physical therapy
    1. Flexibility Exercises with hamstring, quadriceps, and heel cord stretches
  5. Patellar counterforce strap
  6. Refractory Cases
    1. Immobilization is rarely needed and only recommended in severe cases
    2. Orthopedic referral if persistent symptoms despite a mature skeleton
  • Course
  1. Self-limited with resolution within 12-24 months and by skeletal maturity (when apophysis fuses)
  • References
  1. Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]
  2. Atanda (2011) Am Fam Physician 83(3): 285-91 [PubMed]
  3. Lintner (2023) Am Fam Physician 108(6): 544-553 [PubMed]
  4. Medlar (1978) J Bone Joint Surg Am 60(8): 1113-6 [PubMed]