Sinding-Larsen-Johansson Syndrome Copy
SLJ syndrome (distal patellar apophysitis) is a stress injury that occurs primarily in active adolescents, typically between the ages of 10 and 15, during a phase of rapid growth. It involves inflammation of the growth plates (apophyses) at the lower end of the patella, where the patellar tendon attaches. It is caused by repetitive stress and microtrauma at the proximal attachment site of the patellar tendon. The growth plates are cartilaginous areas in long bones from which a child’s bones grow. They are softer and more vulnerable than mature bone tissue.
Symptoms and Diagnosis
Our 13-year-old patient presented with pain on exertion and swelling in the area of the right kneecap, as well as limited range of motion when squatting.
Diagnosis and Treatment
The MRI images revealed thickening of the patellar tendon at its proximal insertion, fluid accumulation behind the kneecap, a signal change in the area of Hoffa’s fat pad, and bone marrow edema at the inferior pole of the patella.
Treatment for Sinding-Larsen-Johansson syndrome typically includes:
– Rest and avoidance of activities that worsen symptoms to relieve pressure on the growth plates and allow the inflammation to subside.
– Physical therapy to strengthen the muscles around the knee and improve flexibility.
– In severe cases, a brace or bandage may be recommended to stabilize the knee.
Differential Diagnosis
In addition to SLJ syndrome, a “patella sleeve fracture” should also be considered in the differential diagnosis of this case. This is an acute chondral or osteochondral avulsion injury that also occurs almost exclusively in children and adolescents. An abrupt tensile force causes a tear of a bony and predominantly cartilaginous portion at the lower pole of the patella.
