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This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Sinding-Larsen Johansson disease is one of the osteochondroses. It can be a cause of anterior knee pain. It is usually seen in a boy in his pre-teens. Pain is usually related to activity and is typically over the inferior pole of the patella. There is a separate article giving an overview of the Osteochondroses.
PathophysiologyOsteochondroses all involve a defect in ossification. The mechanism in Sinding-Larsen Johansson disease is thought to be persistent traction at the cartilaginous junction of the patella and the patellar ligament/tendon (tendon and ligament are interchangeable terms here), usually at inferior patellar pole.1 It is essentially a chronic stress injury with overuse of the patella-patellar tendon junction.2 Similar symptoms can sometimes occur proximally, at the junction of the quadriceps tendon and the patella.3
Presentation- Activity related anterior knee pain
- On examination there is inferior patella tenderness
Investigations- Knee X-ray: can show calcification or ossification at the junction between the patella and the patella ligament
- MRI can be used4,5
Management- Physiotherapy is the mainstay of treatment, including quadriceps strengthening exercises.
- Surgery is not usually needed.
Prognosis- As the skeleton matures, symptoms usually improve and in this way it is regarded as a self-limiting process. However, symptoms may be present for at least a year.
- A case report has presented a case of a pathological patellar fracture through the site of an old Sinding-Larsen Johansson lesion.6
Document references
- Wheeless' Textbook of Orthopaedics; Sinding-Larsen-Johanssen disease
- Sullivan JA; Osgood-Schlatter Disease. eMedicine. Last Updated Jan 5, 2007.
- Tyler W, McCarthy EF; Osteochondrosis of the superior pole of the patella: two cases with histologic correlation. Iowa Orthop J. 2002;22:86-9. [abstract]
- Lamoureux C, Kilcoyne RF; Patella, Fractures. eMedicine. Last Updated May 24, 2007.
- Peace KA, Lee JC, Healy J; Imaging the infrapatellar tendon in the elite athlete. Clin Radiol. 2006 Jul;61(7):570-8. [abstract]
- Freedman DM, Kono M, Johnson EE; Pathologic patellar fracture at the site of an old Sinding-Larsen-Johansson lesion: a case report of a 33-year-old male. J Orthop Trauma. 2005 Sep;19(8):582-5. [abstract]
Acknowledgements EMIS is grateful to Dr M Preston for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 8738Document Version: 1
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Last Updated: 24 Jul 2008Review Date: 24 Jul 2010
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
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