Sinding-Larsen-Johansson syndrome – Pain at the bottom of the kneecap
This disease refers to an inflammation to the bone growth plate at the bottom of the kneecap which occurs in younger athletes,
usually in the age range of 7 to 12 years, on average.
The large muscle on the front of the thigh (quadriceps) attaches to the kneecap which in turn is attached to the shin bone (tibia) via the patellar tendon.
In children, the segment of the kneecap from which the patellar tendon originates is separated from the bulk of the kneecap by a growth plate.
This growth plate allows bone growth to occur. However it is also a site of weakness in the bone.
Sinding-Larsen-Johansson Syndrome can be confused with patella tendonitis or Osgood Schlatter Disease, which is typically more common in older patients.
usually in the age range of 7 to 12 years, on average.
The large muscle on the front of the thigh (quadriceps) attaches to the kneecap which in turn is attached to the shin bone (tibia) via the patellar tendon.
In children, the segment of the kneecap from which the patellar tendon originates is separated from the bulk of the kneecap by a growth plate.
This growth plate allows bone growth to occur. However it is also a site of weakness in the bone.
Sinding-Larsen-Johansson Syndrome can be confused with patella tendonitis or Osgood Schlatter Disease, which is typically more common in older patients.
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Aggressive and repeated contraction of the thigh muscle can injure the growth plate.
This commonly occurs in sports which involve running and jumping and occurs during a period of rapid growth. During rapid growth, the thigh muscle and patellar tendon become tighter as the bones grow. This leads to increased pulling of the patellar tendon on the kneecap and growth plate. Pain is felt where the patellar tendon attaches to the kneecap. The pain is felt most commonly during activity or exercise. The bottom of the kneecap may also be tender to touch and swollen. |
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Treatment
In general, Sinding-Larsen-Johansson Syndrome will improve over time, although athletes can see flare-ups depending upon their volume of activity. The flare-ups should subside once the growth plate has closed.
Relative rest and icing is a good first step when in pain.
Stretching and improving flexibility of the hamstring and quadriceps muscles can be helpful to prevent return of pain once it is under control.
In general a patella strap that is typically not as helpful as in Osgood Schlatter Disease.
Control lower limb biomechanical abnormalities with the use of orthotics, together with muscle control strengthening.
Return to Play
Mild Sinding-Larsen-Johansson Syndrome does not require restriction from activities, as the athlete can usually participate on an as tolerated basis.
Moderate pain may require restriction from activities for several weeks to a month, until the pain is better under control and flexibility of the hamstring and quadriceps muscles have improved.
In rare cases, the athlete may need to be placed in a straight leg knee immobilizer and crutches to completely remove tension from the patella and allow it to heal appropriately.
Sports Considerations
An athlete should consider cross training and conditioning in a sport with less impact, such as swimming or biking.
In general, Sinding-Larsen-Johansson Syndrome will improve over time, although athletes can see flare-ups depending upon their volume of activity. The flare-ups should subside once the growth plate has closed.
Relative rest and icing is a good first step when in pain.
Stretching and improving flexibility of the hamstring and quadriceps muscles can be helpful to prevent return of pain once it is under control.
In general a patella strap that is typically not as helpful as in Osgood Schlatter Disease.
Control lower limb biomechanical abnormalities with the use of orthotics, together with muscle control strengthening.
Return to Play
Mild Sinding-Larsen-Johansson Syndrome does not require restriction from activities, as the athlete can usually participate on an as tolerated basis.
Moderate pain may require restriction from activities for several weeks to a month, until the pain is better under control and flexibility of the hamstring and quadriceps muscles have improved.
In rare cases, the athlete may need to be placed in a straight leg knee immobilizer and crutches to completely remove tension from the patella and allow it to heal appropriately.
Sports Considerations
An athlete should consider cross training and conditioning in a sport with less impact, such as swimming or biking.