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Sinding-Larsen-Johansson disease

Sinding-Larsen-Johansson disease (SLJ), also known as Sinding-Larsen´s disease or Larsen-Johannson syndrome, affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella, and represents a chronic traction injury of the immature osteotendinous junction. It is a closely related condition to Osgood-Schlatter disease. Some authors class SLJ as jumper's knee in the paediatric setting 2.

Epidemiology

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 particularly prone to SLJ 4.

Clinical presentation

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

Radiographic features

Plain film

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

Ultrasound

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

MRI

MRI is crucial in assessment of extensor mechanism injuries. In SLJ the proximal and posterior part of the patellar tendon is thickened with high T2/STIR signal, often extending into the adjacent fat and inferior pole of the patella.

Treatment and prognosis

With rest and quadriceps flexibility exercises the condition settles 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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