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Sinding-Larsen-Johansson Disease
Aka: Sinding-Larsen-Johansson Disease, Sinding-Larsen-Johansson, Larsen-Johansson Disease, Patella Apophysitis, Köhler Patella
- See Also
- Osteochondrosis
- Osgood Schlatter
- Pathophysiology
- Apophysitis secondary to traction injury at the inferior pole of the Patella
- Contrast with Osgood Schlatter which is aphophysitis at the tibial tubercle
- Epidemiology
- Ages 10-13 years old
- Symptoms
- Anterior Knee Pain
- Worse with jumping or direct pressure on the inferior Patellar pole
- Signs
- Point tenderness at the Patella inferior pole
- Imaging
- Knee XRay
- Rule-out Fracture, tumor, Patellar sleeve avulsion or ostemyelitis
- May demonstrate partial Patellar avulsion with overlying swelling
- Abnormal calcification at Ossification Centers
- Bedside Ultrasound
- Fragmentation of the inferior Patella (compared with opposite side)
- Differential Diagnosis
- Osgood-Schlatter (affects tibial tubercle)
- Management
- Relative rest
- Analgesics (NSAIDs, Acetaminophen)
- Flexibility Exercises with hamstring, quadriceps, and heel cord stretches
- Patellar counterforce strap
- Immobilization is rarely needed and only recommended in severe cases
- Orthopedic referral if persistent symptoms despite a mature skeleton
- Course
- Self-limited with resolution within 12-24 months and by skeletal maturity (when apophysis fuses)
- References
- Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]
- Atanda (2011) Am Fam Physician 83(3): 285-91 [PubMed]
- Medlar (1978) J Bone Joint Surg Am 60(8): 1113-6 [PubMed]