Sinding Larsen Johansson Syndrome

Original Editor - Andrew Klaehn

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This is a wiki created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy

add text here related to databases searched, keywords, and search timeline

Definition/Description

add text here

Epidemiology /Etiology

add text here

Characteristics/Clinical Presentation

add text here

Differential Diagnosis

add text here

Examination

add text here

Medical Management (current best evidence)

add text here

Physical Therapy Management (current best evidence)

add text here

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

References

see adding references tutorial.

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).  A safe progression back to sports or high-level activities may happen when each of the following happens in this specific order:

1. The lower kneecap is no longer tender and there is no swelling.
2. The injured knee can be fully straightened and bent without pain.
3. The knee and leg have regained normal strength compared to the uninjured knee and leg
4. Ability to jog straight ahead without limping.
5. Ability to sprint straight ahead without limping.
6. Ability to do 45-degree cuts.
7. Ability to do 90-degree cuts.
8. Ability to do 20-yard figure-of-eight runs.
9. Ability to do 10-yard figure-of-eight runs.
10. Ability to jump on both legs without pain and hop on the injured leg without pain.
    

Resources

www.astym.com/

For a video presentation on SLJ, please click on link below

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

References: www.childrensmemorial.org/depts/sportsmedicine/slj.aspx www.kneeclinic.info/problems_other_knee_conditions.php

Recent Related Research (from Pubmed)

Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=12Ak-Eek5aC7Xsv1jzsjisgAnyzqbi_469jPg8m6jSKgUy8kC0|charset=UTF-8|short|max=10: Error parsing XML for RSS

References

References will automatically be added here, see adding references tutorial.