Sinding-Larsen-Johansson Syndrome
Sinding-Larsen-Johansson syndrome (SLJ) is a cause of knee pain in patients with an immature skeleton. It is an apophysitis, an inflammatory process of the lower part of the patella, at the insertion point of the patellar ligament.
The syndrome is caused by repetitive traction of the patellar ligament at the lower pole of the patella, which is still partially cartilaginous in children and adolescents with an immature skeleton.
For this reason, the condition is most frequently observed in boys, usually between 10 and 14 years of age, who practice physical exercises that involve bending and straightening the knee and jumping, such as soccer, running, volleyball, gymnastics, among others.
What does the patient feel?
Patients with Sinding-Larsen-Johansson syndrome typically experience pain in the front of the knee, in the lower part of the patella, which gets worse when he knee is bent. In most cases, this pain becomes more intense after playing sports and improves when the patient rests. Signs of inflammation at the site of the pain, such as swelling and increased skin temperature, may be observed.
It is important to note that this condition can be a cause of knee pain in children and adolescents, and parents often report that their children have this type of discomfort.
How is the diagnosis made?
The diagnosis of Sinding-Larsen-Johansson syndrome is made through a good conversation between the doctor, the patient and the parents. This way, it is possible to know the characteristics of the discomfort.
A thorough physical examination is also very important, since there are other conditions that can cause similar pain, however, in slightly different locations, such as:
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Distal quadriceps tendonitis;
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Prepatellar bursitis;
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Chondromalacia of the patella;
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Fracture of the patella;
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Superficial and deep infrapatellar bursitis;
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Patellar tendonitis;
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Hoffitis;
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Osgood-Schlatter disease.
Some imaging tests can help when there is a suspicion of SLJ syndrome. They are:
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Knee X-rays;
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Ultrasonography;
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Nuclear magnetic resonance imaging.
Treatment
Most of the time, Sinding-Larsen-Johansson syndrome is treated non-operatively. During periods of inflammation, when the patient complains of more intense pain, partial rest may be recommended, with a temporary reduction in sports and exercise. In addition, analgesic and anti-inflammatory medications may be prescribed.
Since the problem is directly related to repeated movements, it is common for us to refer patients to physiotherapy, so that the pain improves more quickly and the patient can begin muscle strengthening work early.
Patients usually experience significant improvement in pain after treatment and after the skeleton has matured.
Surgical treatment for Sinding-Larsen-Johansson syndrome is rare and is usually reserved for adult patients who end up with calcification near the lower pole of the patella, which can cause repeated tendonitis.
Strengthening specific muscles according to the sports gesture of patients who practice high-intensity activities is important to try to reduce the overload in the region and prevent the onset of both SLJ syndrome and other problems that cause pain in the front of the knee.
