Sinding Larsen Johanssons disease


What is Sinding-Larsen-Johansson disease?

Sinding-Larsen-Johansson disease, also known as enthesitis apicis patellae, involves pain at the lower edge or apex of the patella (kneecap). Along with Osgood-Schlatter disease, it is one of the most common reasons adolescents visit a pediatric orthopedic surgeon for knee-related issues. The extension of the knee is facilitated by the quadriceps femoris muscle, the strongest muscle in the human body, originating from multiple points on the pelvis and converging with a common tendon attached to the upper edge of the patella. The force of the quadriceps is then transmitted over the patella and the patellar ligament to the tibia, specifically to the bony prominence on the front side, the tibial tuberosity. Sinding-Larsen-Johansson disease develops due to repetitive microtrauma, stretching-pulling at the origin of the patellar ligament from the apex of the patella. Like Osgood-Schlatter disease, Sinding-Larsen-Johansson disease occurs during the pubertal growth spurt. However, unlike Osgood-Schlatter, which is more common in boys, Sinding-Larsen-Johansson affects both genders equally.

How to diagnose Sinding-Larsen-Johansson disease?

In Sinding-Larsen-Johansson disease, children complain of pain at the front of the knee, specifically at the top of the patella. There is no traumatic background, and the pain gradually develops, intensifying after sports activities. Pain is often bilateral. Clinical examination may not reveal swelling, but palpation consistently induces strong tenderness at the apex of the patella. To effectively elicit patellar tenderness during the clinical examination, it is necessary to slightly lift the patella with the other hand, making the apex more accessible for palpation. A lateral X-ray of the knee typically shows a mild shadow or osteolysis above the apex of the patella, although X-ray imaging is not essential during the initial examination. Pain on the inside of the knee, just beside the patella, can be caused by a thickened medial plica, which children often describe as pain at the start of activities.

How to treat Sinding-Larsen-Johansson disease?

 The treatment for Sinding-Larsen-Johansson disease is conservative, involving physical therapy. Jumping and hopping should be discontinued, as these activities subject the knee to pronounced forces. Sports activities should be modified, with an emphasis on cycling. Initiating stretching exercises for the quadriceps muscles, which are typically shortened, is crucial. Persistent muscle stretching should be combined with stretching of the muscle fascia using a Black roll. As Sinding-Larsen-Johansson disease often occurs in athletes involved in jumping sports, they should be advised on proper jumping techniques. Physical therapy is usually effective in resolving Sinding-Larsen-Johansson disease. In cases where prolonged physical therapy does not alleviate the pain, orthopedic insoles with a supination wedge can be considered. However, in some cases, surgical intervention, such as knee arthroscopy to examine the apex of the patella and potentially refresh the origin of the patellar ligament with a needle, may be required.

Scroll to Top