Sinding-Larsen-Johansson disease

Sinding-Larsen-Johansson disease (SLJ), also known as Sinding-Larsen disease or Larsen-Johansson syndrome, affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella. It represents a chronic traction injury of the immature osteotendinous junction. It is a closely related condition to Osgood-Schlatter disease. Some authors classify SLJ as a paediatric version of "jumper's knee2.


Unlike "jumper's knee" which is seen at any age, Sinding-Larsen-Johansson disease is seen in active adolescents, typically between 10-14 years of age 1. Children with cerebral palsy are also prone to SLJ 4.

Clinical presentation

Presentation is with point tenderness at the inferior pole of the patella associated with focal swelling.

Radiographic features

Conventional radiography

Early findings are subtle or absent. Thickening of the proximal patellar tendon may be seen with possible stranding of the adjacent portions of Hoffa's fat pad. Dystrophic calcification/ossification may eventually occur.

  • thickening and heterogeneity of the proximal patellar tendon, especially involving the posterior fibres (which attach to the patella rather than pass over the surface of the patella to blend with the quadriceps tendon)
  • focal regions of hypoechogenicity may be seen, representing small tears.

MRI is useful in assessment of extensor mechanism injuries.

  • the proximal and posterior part of the patellar tendon is thickened with high T2/STIR signal
  • often high T2/STIR signal in the inferior pole of the patella and in in the adjacent fat

Treatment and prognosis

With rest and quadriceps flexibility exercises the condition resolves with no secondary disability.

History and etymology

The entity was described by the Norwegian physician Christian Magnus Falsen Sinding-Larsen (1866-1930) in 1921 5. The Swedish physician Sven Christian Johansson (1880-1959) described the same entity independently in 1922 6.

Differential diagnosis

Imaging differential considerations include

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The knee is a complex synovial joint that can be affected by a range of pathologies:

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