Johansson-Sinding-Larsen syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Aseptic necrosis of patella, Osteochondrosis of patella, Sinding-Larsen-Johansson Syndrome.

Overview

Sinding-Larsen-Johansson Syndrome is a type of osteochondrosis affecting the attachment of the patellar tendon to the patella and characterised by tenderness and localized swelling of the patella.[1]

Pathophysiology

The mechanism in Sinding-Larsen Johansson disease is the persistent traction at the cartilaginous junction of the patella and the patellar ligament/tendon, usually at the inferior patellar pole causing bone fragmentation of the inferior portion of the patella. It is essentially a chronic stress injury with overuse of the patella-patellar tendon junction.

Causes

Things that can contribute to developing Sinding-Larsen-Johansson Syndrome include recent growth spurts, inappropriate or a sudden increase in training or sporting activity, inappropriate footwear, lower limb muscle tightness or weakness particularly the quadriceps, poor foot posture, tight lateral retinaculum or patella malalignment, poor lower limb dynamic stability and poor lower limb biomechanics.

Differentiating type page name here from other Diseases

Patella avulsion fractures, Patella stress fracture, Bipartite patella (type I), Osgood-Schlatter disease, Jumper's knee.

Epidemiology and Demographics

Prevalence is unknown. This disease occurs mostly in adolescents who are active during their growth spurts, especially in young male athletes practising sport.

Diagnosis

Symptoms

Sinding-Larsen-Johansson Syndrome causes activity-related anterior knee pain.On examination there is inferior patella tenderness. Pain, swelling or tenderness is felt at the base of the patella, where the patellar tendon inserts into the patella.

Laboratory Findings

Knee X-ray: can show calcification or ossification at the junction between the patella and the patella ligament.

MRI

MRI scan can be used.

Treatment

Rest[2]:Limit the activities as much as possible and keep the weight off your knee.

Ice: Apply ice or a cold compress to the affected area for 15-20 minutes every few hours for 2 to 3 days or until the pain goes away.

Compress: Give your knee added support by using a brace, band, or strap.

Elevate: Try to keep the knee higher than your heart to help keep the swelling down.

Physiotherapy[3] 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.

Pharmacotherapy

Painkillers like ibuprofen and acetaminophen can help relieve pain and reduce swelling.

Primary Prevention

Stop doing an activity that causes pain in the knee at first signs of irritation. Try to limit the activity until the pain goes away. It's vital to warm up well and stretch before exercising or playing sports. Take a light jog around the track or field for a few minutes to get your blood circulating, then do some dynamic stretching. Massage is beneficial to reduce chronic tightness in your quadriceps, hamstrings, adductors or calf muscles.

References

  1. "Sinding-Larsen Johansson Disease | Doctor | Patient.co.uk". Retrieved 2012-08-20.
  2. "Sinding-Larsen-Johansson Syndrome". Retrieved 2012-08-20.
  3. "Sinding Larsen Johansson Syndrome". Retrieved 2012-08-20.


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