Table of Contents
Sinding-Larsen-Johansson disease is a traction tendinitis of the distal pole of the patella, caused by microtrauma. It is seen in growing individuals; who have pain at the inferior pole of the patella in association with running and jumping. Typical clinical signs are point tenderness at the inferior pole of the patella, swelling, limitation of motion, and a protective limp. Radiography may show fragmentation or ossification of the distal pole of the patella where the tendon inserts.
The treatment consists of alleviation of symptoms, as the syndrome is self-limiting. Resolution may occur within 12 months. During this time there should be restriction of activities. Strength training and stretching are components of rehabilitation. Education of the athlete is important. When the athlete is fully grown, there are usually no residual problems. It should be remembered that the differential diagnosis could be stress fracture of the patella.
Traction tendinitis of the distal patellar tendon, known as Osgood-Schlatter disease, is common in adolescent athletes and is seen in 13% of cases of knee pain in a typical sports medicine center. These adolescents have often undergone rapid growth and are involved in sports requiring tensile quadriceps contraction, such as jumping and running.In Osgood-Schlatter disease the tibial attachment of the patellar tendon becomes a seat of inflammation and degradation of bone (traction apophysitis of the tibial tuberosity).
The pole of the patellar tendon causes detachment of small cartilage fragments from the tibial tuberosity. The cause of this injury is unclear; possibly it is traction microtrauma. Very active boys between 10–16 are primarily affected, and the symptoms disappear when the athlete is fully grown.
Symptoms and Diagnosis
- Pain is felt at the attachment of the tendon to the tibia during and after physical activity.
- Pain can be triggered by contraction of the quadriceps against resistance.
- Localized tenderness and soft tissue swelling of the attachment of the patellar tendon to the tibia.
- The skin may be hot and red, with a prominence at the affected area.
- Tightness of the muscles is often present.
- An X-ray examination may show fragmentation of the bone; soft tissue swelling and thickening of the distal portion of the patellar tendon may also be seen.
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