Sinding Larsen Johansson Syndrome
This is a juvenile Osteochondritis/or traction apophysitis at the inferior (bottom) pole of the patella. It is an overuse knee injury in children between 7- 15 years of age.
Causes of Sinding Larsen Johansson Syndrome In adolescents, the skeletal system is immature, a strong repetitive traction pull at the inferior pole of the patella where the patellar ligament attaches results in this condition. As a result, the knee extensor mechanism is disrupted. It is similar to Osgood-Schlatter syndrome. There is a higher
incidence of inactive children during the adolescent growth spurt.
Stages of Sinding Larsen Johansson Syndrome During the development phase of bone, it goes through different stages as –
• The tibial tuberosity is initially cartilaginous known as the Cartilaginous stage. • It then enters the Apophyseal stage when the secondary ossification center (apophysis) appears. • The unity of the proximal tibial epiphysis with the tibial apophysis marks the Epiphyseal stage and • Lastly, when the growth plates fuse, the Bony stage has been reached.
Children are most susceptible to Sinding-Larsen-Johansson syndrome when their bones are in the (2nd) Apophyseal
stage. During this stage, the apophysis is unable to withstand
high tensile forces. When presented with strong, repetitive muscle contractions, micro-fractures occur in the
immature area. The separation results in symptoms typical to Osgood Schlatter’s Disease, as well as irregular bone growth that explain an enlarged inferior pole of the patella afterward.
Symptoms: Sinding Larsen Johansson syndrome presents in growing boys and girls as: • Local pain, swelling, and tenderness over the tibial tuberosity • Pain is experienced during exercise (e.g. running, jumping) or with direct contacts, such as in kneeling. • Pain in activities like stair climbing, squatting, and kneeling.
• Quadriceps weakness can be present in chronic cases. • Maybe or may not be in both knees. • Symptoms get better with rest. • A longstanding case of this syndrome can result in an avulsion fracture of the patellar tendon, which can severely affect the ability to walk or run. Fortunately, the condition can be successfully managed with physiotherapy.
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