Advertising Survey

We would like your input on how advertising is currently used in the site.

Please take this short survey to help us out.

Hide this message

Sinding-Larsen Johansson Disease

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

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.

Pathophysiology

Osteochondroses 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 the 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.

Differential diagnosis1

Investigations

  • Knee X-ray: can show calcification or ossification at the junction between the patella and the patella ligament.
  • MRI scan can be used.4,5

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

  1. Sinding-Larsen-Johanssen disease, Wheeless' Textbook of Orthopaedics
  2. Sullivan AJ; Osgood-Schlatter Disease, eMedicine, Mar 2009
  3. 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]
  4. Lamoureux C; Patella Fracture Imaging, eMedicine, Sep 2010
  5. Peace KA, Lee JC, Healy J; Imaging the infrapatellar tendon in the elite athlete. Clin Radiol. 2006 Jul;61(7):570-8. [abstract]
  6. 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 Richard Draper for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2011.
Document ID: 8738
Document Version: 2
Document Reference: bgp26142
Last Updated: 5 Jan 2011
Provide feedback