Presentation
Anterior knee pain exacerbated by movements. Swelling of the inferior pole of the patella and the tibial tuberosity. No history of trauma.
Patient Data
Presence of ossicles in both proximal insertion (inferior pole of patella) and distal insertion (tibial tuberosity) of the patellar tendon.
Features consistent with Sinding-Larsen Johansson syndrome with Osgood-Schlatter disease.
Case Discussion
The Sinding-Larsen Johansson syndrome 1,2 and Osgood Schlatter disorder are osteochondroses of the inferior pole of the patella and the tibial tuberosity respectively. They are associated with activities like running, hiking. They can occur simultaneously as in this case.
The main differential diagnosis of Sinding-Larsen Johansson syndrome is patellar sleeve fracture 3. To rule it out, 3 elements:
- There was no trauma, or acute presentation of pain. The evolution was progressive
- On X rays 4:
- the osteochondrosis ossicle has a rounded and corticated edge (whereas the edges of a sleeve fracture are angulated with no cortication)
- a sleeve fracture generally has a crescentic appearance of a cat's claw, not seen in this case
3. An MRI was performed (not shown) revealed edema and joint effusion. There was no articular cartilage separation of sleeve fractures