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Updated: May 31 2021

Sinding-Larsen-Johansson Syndrome

Images tendinopathy.jpg
  • Summary
    • Sinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment.
    • Diagnosis is made clinically with tenderness over the inferior pole of the patella and radiographs of the knee may show a spur at the inferior pole of the patella.
    • Treatment is nonoperative with NSAIDs, activity modifications and physical therapy with most cases resolving over time. 
  • Epidemiology
    • Demographics
      • more common in adolescence
    • Location
      • patellar tendon insertion at the inferior pole of the patella
  • Etiology
    • Pathophysiology
      • chronic injury
      • similar pathogenesis to Osgood-Schlatter
        • similar to Osgood-Schlatter disease which is at the distal attachment of the patella tendon
      • overuse causes a traction apophysitis
  • Classification
      • Blazina Classification
      • Stage 1
      • Pain occurs after activity
      • Stage 2
      • Pain present while performing activity and persists after activity
      • Stage 3
      • Pain affecting/limiting function during activity
  • Presentation
    • History
      • insidious onset of pain on anterior aspect of knee after or during activity
    • Physical exam
      • tenderness over inferior patella
      • swelling
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral of knee
      • findings
        • may be normal
        • may show spur at inferior pole of patella
    • MRI
      • indications
        • if diagnosis unclear
      • views
        • inflammation best seen on T2 sagitals
        • bony spurs best seen on T1 sagitals
  • Treatment
    • Nonoperative
      • activity modifications, NSAIDS, physical therapy
        • indications
          • mainstay of treatment
          • usually a self limiting process
    • Operative
      • debridement of damaged tissue/stimulation of healing response
        • in some cases refractory to nonoperative treatment
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