Sinding Larsen Johansson Syndrome

Sinding-Larsen and Johansson syndrome

Synonyms: Most commonly known as Jumper's knee, but is also known medically under several different conditions such as apophysitis of the distal pole of the patella, patellar osteochondrosis, adolescent patellar chondromalacia, juvenile osteopathia patellae, osteochondritis patellae juvenilis or distal patella apophysitis.

Etiology:  SLJ is an overuse syndrome that affects the proximal attachment of the patellar tendon into the inferior patellar pole. It is caused by microtrauma to this area and can be followed by calcification and ossification if the condition becomes chronic.  It typically affects children and adolescents between the ages of 10 and 15 y.o. especially when they go through growth spurts.  However, it can also affect active adults who run for moderate to long distances or are involved in sports that require much jumping or squatting. It is similiar to Osgood-Schlatter's disease of the distal patellar tendon.

Typical Signs and Symptoms: US or MRI imaging may show osseus fragmentation of the distal patellar pole, or it may be irregular, with chondral changes and thickening at the insertion of the patellar tendon. Any activity, from normal walking to climbing stairs, may increase the person's pain depending upon the severity of the condition. In less severe cases, a person may not begin to feel pain until after extended activity, such as running for several miles. Tenderness to touch, limping and a tender bump in the infrapatellar area are all common signs. Lower extremity neurovascular signs or crepitus in the knee are rare and may be indicative of another pathology.

Physical Therapy Treatment:  Icing or ice massage, especially right after activity, and referral to an MD for antiinflammatories should be initiated, if not already done.  First and foremost, physical therapists must educate the patient on activity modification. Kneeling, jumping, squatting, stair climbing, and running on the affected knee should be avoided at least for the short term.  A formal posture, gait, running and jumping-landing analysis should be performed to identify any biomechanical insufficiencies. Orthotics may need to be fitted to help stabilize hind foot valgus, overpronation or pes planus problems. Lower extremity strength needs to be tested, especially at the ankle and the hip to find any muscle weaknesses that may be contributing to the overuse syndrome. Core strengthening should be initiated since most of these people are athletes and central stability is required for proper distal mobility.  An adjunct treatment that has been proven beneficial for tendonitis or tenosynivitis problems is the ASTYM system (see below for link to more information on this system).

  http://www.dailymotion.com/video/xa38v7_dr-marshall-discusses-sindinglarsen_sport