Charlie Kornberg's Musculoskeletal Physiotherapy Home Page

Sinding-Larsen-Johansson Disease

Definition

Anterior knee pain may be due to traction apophysitis of the lower pole of the patella, known eponymously as Sinding - Larsen - Johannson Disease.

Depiction of the fragmentation seen in the inferior pole of the patellar in Sinding-Larsen-Johansson Disease.

Classification

The radiological findings have been classified according to the severity of the disease:

Stage I - Normal

Stage II - Irregular calcification at the inferior pole of the patella

Stage III - Coalescence of the calcification

Stage IVA - Incorporation of the calcification into the x-ray (normal x-ray)

Stage IVB - Coalesced calcific mass separate from the patella.

Clinical Features

The patient is usually an adolescent who complains of anterior knee pain aggravated by running and jumping. The typical findings are of local tenderness at the inferior pole of the patella, and characteristic appearances on plain radiography of fragmentation of the lower pole of the patella. The differential diagnosis include patellar tendinosis and patellar fracture.

Treatment

As the condition appears to have no long-term sequelae, reassurance is essential. Treatments include activity restriction to the point of pain relief or significant reduction, exercises, and graduated functional restoration.

The concepts presented here are entirely the author's own (unless expressly stated) and do not represent the thoughts or ideas of any other person.

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