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Sindig-Larsen-Johanssen disease

- Discussion:
    - cause of discomfort in anterior aspect of the knee;
    - caused by persistent traction at the cartilaginous junction of patella & patellar ligament, usually at inferior patellar pole;
    - usually seen in an active preteen boy who complains of activity-related pain;
    - differential diagnosis:
            - pediatric patella avulsion fractures
            - patellar stress fracture;
            - bipartite patella (type I)
            - Osgood Schlatter's disease)
                    - calcification is present at the inferior pole of the patella (where as tenderness or calcification along the tibial tubercle;
            - jumper's knee is considered in older adolescents;

- Exam:
    - tenderness is found at inferior pole of patella;
    - occasionally, similar symptoms can occur proximally, at the junction of the quadriceps tendon and the patella;

- X-rays:
    - may show varying amounts and shapes of calcification or ossification at junction of the patella and the ligament;

- Treatment:
    - does not require operative treatment;
    - responds to quadriceps strengthening exercises;
    - symptoms usually resolve with progressive skeletal maturation, but may take well over one year;
    - in rare instances, operative debridement of necrotic intratendinous tissue causing a jumper's knee may be needed in patients who do not respond to non-operative management

Sinding-Larsen-Johansson disease. Its etiology and natural history.