Sinding-Larsen-Johansson disease

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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~~It 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 a paediatric version of "jumper's knee ~~in the paediatric setting~~ " ².

Epidemiology

Unlike ~~jumper~~"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~~ Children with cerebral palsy are ~~particularly prone~~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

Plain filmConventional radiograph

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 ~~potentially seen~~. Dystrophic calcification ~~/ ossification~~/ossification may eventually ~~be present~~occur.

Ultrasound

~~Thickening~~

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~~ pass over the surface of the patella to blend with the quadriceps tendon)~~. Focal~~
focal regions of hypoechogenicity may be seen, representing small tears.

MRI

MRI is ~~crucial~~useful 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~~high T2/STIR signal in the ~~adjacent fat and~~ inferior pole of the patella. and in in the adjacent fat

Treatment and prognosis

With rest and quadriceps flexibility exercises the condition ~~settles~~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

Osgood Schlatter disease: inferior attachment of the patellar tendon into the tibial tuberosity
jumper's knee: same location and similar pathology, but seen in adults~~; some~~ (some authors do not distinguish between ~~the two~~ SLJ and jumper's knee) ²
patellar sleeve fractures: same age group; avulsion of inferior pole cartilage, often with small fracture fragment²
bipartite patella / normal inferior pole "fragmentation" ³
infrapatellar bursitis ⁴

-<p><strong>Sinding-Larsen-Johansson disease</strong> <strong>(SLJ)</strong>, also known as <strong>Sinding-Larsen´s disease </strong>or <strong>Larsen-Johannson syndrome</strong>, affects the proximal end of the patellar tendon as it inserts into the inferior pole of the <a href="/articles/patella">patella</a>, and represents a chronic traction injury of the immature osteotendinous junction. It is a closely related condition to <a href="/articles/osgood-schlatter-disease">Osgood-Schlatter disease</a>. Some authors class SLJ as <a href="/articles/jumper-knee">jumper's knee</a> in the paediatric setting <sup>2</sup>.</p><h4>Epidemiology</h4><p>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 <sup>1</sup>. Children with cerebral palsy are particularly prone to SLJ <sup>4</sup>.</p><h4>Clinical presentation</h4><p>Presentation is with point tenderness at the inferior pole of the patella associated with focal swelling.</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Early findings are subtle or absent. Thickening of the proximal patellar tendon may be seen with stranding of the adjacent portions of <a href="/articles/hoffas-fat-pad">Hoffa's fat pad</a> potentially seen. Dystrophic calcification / ossification may eventually be present.</p><h5>Ultrasound</h5><p>Thickening and heterogeneity of the proximal patellar tendon, especially involving the posterior fibres (which attach to the patella rather than blending with the <a href="/articles/quadriceps-tendon">quadriceps tendon</a> and pass over the surface of the patella). Focal regions of hypoechogenicity may be seen representing small tears.</p><h5>MRI</h5><p>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.</p><h4>Treatment and prognosis</h4><p>With rest and quadriceps flexibility exercises the condition settles with no secondary disability.</p><h4>History and etymology</h4><p>The entity was described by the Norwegian physician <strong>Christian Magnus Falsen Sinding-Larsen </strong>(1866-1930) in 1921 <sup>5</sup>. The Swedish physician <strong>Sven Christian Johansson</strong> (1880-1959) described the same entity independently in 1922 <sup>6</sup>.</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include</p><ul>
+<p><strong>Sinding-Larsen-Johansson disease</strong> <strong>(SLJ)</strong>, also known as <strong>Sinding-Larsen´s disease </strong>or <strong>Larsen-Johannson syndrome</strong>, affects the proximal end of the patellar tendon as it inserts into the inferior pole of the <a href="/articles/patella">patella</a>, It represents a chronic traction injury of the immature osteotendinous junction. It is a closely related condition to <a href="/articles/osgood-schlatter-disease">Osgood-Schlatter disease</a>. Some authors class SLJ as a paediatric version of "<a href="/articles/jumper-knee">jumper's knee</a>" <sup>2</sup>.</p><h4>Epidemiology</h4><p>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 <sup>1</sup>. Children with cerebral palsy are are also prone to SLJ <sup>4</sup>.</p><h4>Clinical presentation</h4><p>Presentation is with point tenderness at the inferior pole of the patella associated with focal swelling.</p><h4>Radiographic features</h4><h5>Conventional radiograph</h5><p>Early findings are subtle or absent. Thickening of the proximal patellar tendon may be seen with possible stranding of the adjacent portions of <a href="/articles/hoffas-fat-pad">Hoffa's fat pad</a>. Dystrophic calcification/ossification may eventually occur.</p><h5>Ultrasound</h5><ul>
+<li>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 <a href="/articles/quadriceps-tendon">quadriceps tendon</a>)</li>
+<li>focal regions of hypoechogenicity may be seen, representing small tears.</li>
+</ul><h5>MRI</h5><p>MRI is useful in assessment of extensor mechanism injuries.</p><ul>
+<li>the proximal and posterior part of the patellar tendon is thickened with high T2/STIR signal</li>
+<li>often high T2/STIR signal in the inferior pole of the patella and in in the adjacent fat</li>
+</ul><h4>Treatment and prognosis</h4><p>With rest and quadriceps flexibility exercises the condition resolves with no secondary disability.</p><h4>History and etymology</h4><p>The entity was described by the Norwegian physician <strong>Christian Magnus Falsen Sinding-Larsen </strong>(1866-1930) in 1921 <sup>5</sup>. The Swedish physician <strong>Sven Christian Johansson</strong> (1880-1959) described the same entity independently in 1922 <sup>6</sup>.</p><h4>Differential diagnosis</h4><p>Imaging differential considerations include</p><ul>
~~-<a href="/articles/jumper-knee">jumper's knee</a>: same location and similar pathology, but seen in adults; some authors do not distinguish between the two <sup>2</sup>~~
+<a href="/articles/jumper-knee">jumper's knee</a>: same location and similar pathology, but seen in adults (some authors do not distinguish between SLJ and jumper's knee) <sup>2</sup>
~~-<a href="/articles/patellar-sleeve-fractures">patellar sleeve fractures</a>: same age group; avulsion of inferior pole cartilage often with small fracture fragment<sup> 2</sup>~~
+<a href="/articles/patellar-sleeve-fractures">patellar sleeve fractures</a>: same age group; avulsion of inferior pole cartilage, often with small fracture fragment<sup> 2</sup>

References changed:

8. http://www.whonamedit.com/synd.cfm/3156.html

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