II. Pathophysiology

  1. Apophysitis secondary to traction injury at the inferior pole of the Patella
  2. Contrast with Osgood Schlatter which is aphophysitis at the tibial tubercle

III. Epidemiology

  1. Ages 10-13 years old

IV. Symptoms

  1. Anterior Knee Pain
  2. Worse with jumping or direct pressure on the inferior Patellar pole

V. Signs

  1. Point tenderness at the Patella inferior pole

VI. Imaging

  1. Knee XRay
    1. Rule-out Fracture, tumor, Patellar sleeve avulsion or ostemyelitis
    2. May demonstrate partial Patellar avulsion with overlying swelling
    3. Abnormal calcification at Ossification Centers
  2. Bedside Ultrasound
    1. Fragmentation of the inferior Patella (compared with opposite side)

VII. Differential Diagnosis

  1. Osgood-Schlatter (affects tibial tubercle)

VIII. Management

  1. Relative rest
  2. Analgesics (NSAIDs, Acetaminophen)
  3. Flexibility Exercises with hamstring, quadriceps, and heel cord stretches
  4. Patellar counterforce strap
  5. Immobilization is rarely needed and only recommended in severe cases
  6. Orthopedic referral if persistent symptoms despite a mature skeleton

IX. Course

  1. Self-limited with resolution within 12-24 months and by skeletal maturity (when apophysis fuses)

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Related Studies

Ontology: Larsen-Johansson syndrome (C0264096)

Concepts Disease or Syndrome (T047)
ICD10 M92.4
SnomedCT 34976002, 203386001, 203389008
English Kohler's disease, Osteochondritis of the patella, Juvenile osteochondrosis of patella, Larsen-Johansson syndrome, larsen-johansson syndrome, kohler's disease, juvenile osteochondrosis of patella (diagnosis), Juvenile osteopathia patellae, Juvenile osteopathia patellae (disorder), Köhler; patella (osteochondrosis), Larsen-Johansson, juvenile; osteochondritis, patellar, osteochondritis; juvenile, patellar, osteochondrosis; Köhler, patella, osteochondrosis; Sinding-Larsen, osteochondrosis; patella (Köhler), patella; Köhler, patella; osteochondrosis (Köhler)
German Juvenile Osteochondrose der Patella
Korean 무릎뼈의 청소년성 골연골증
Spanish osteopatía rotuliana juvenil, osteopatía rotuliana juvenil (trastorno), síndrome de Larsen - Johansson, osteopatía patelar juvenil
Dutch Köhler; patella (osteochondrose), juveniel; osteochondritis, patellair, osteochondritis; juveniel, patellair, osteochondrose; Köhler, patella, osteochondrose; Sinding-Larsen, osteochondrose; patella (Köhler), patella; Köhler, patella; osteochondrose (Köhler), Juveniele osteochondrose van patella