Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player

Anterior knee pain in young athletes: Osgood Schlatter or Sinding-Larsen-Johansson disease?

ABSTRACT

Osgood-Schlatter disease (OSD) and Sinding-Larsen-Johansson disease (SLJD) are commonly diagnosed conditions in young, athletic patients who present with anterior knee pain. Despite the familiarity many clinicians have with OSD because of its frequent diagnosis, it does not differ much from SLJD in clinical presentation. Although these diseases generally are self-limiting, diagnostic imaging studies can help clinicians make the correct diagnosis, helping patients avoid progressing to advanced disease states that would require extended rest time, prolonged pain, and potential surgical intervention.

Acute presentation of Sinding-Larsen-Johansson disease simulating patella sleeve fracture: A case report

OBJECTIVES

Diagnosis of Sinding-Larsen-Johansson disease may not be an easy task. Several sport-related conditions affect the distal pole of the patella in the adolescent, and treatment varies considerably. The article describes a patient that had radiographic features of Sinding-Larsen-Johansson disease associated with an atypical acute presentation.

METHODS

Case report and literature review.

RESULTS

A 10-year-old boy presented with a sudden pain after a noncontact soccer injury. He had tenderness and swelling over the patella. Radiographs showed minimally displaced distal patellar ossicle. Magnetic resonance imaging excluded sleeve cartilaginous injury and documented Sinding-Larsen-Johansson disease. The knee was immobilized briefly. There was complete healing of the injury in 4-week follow-up radiographs.

CONCLUSION

Emergency physicians, radiologists, and orthopedic surgeons should be aware of the acute presentation of Sinding-Larsen-Johansson disease after knee injuries.

Clinical Outcome of Arthroscopic Lateral Retinacular Release for Symptomatic Bipartite Patella in Athletes

PURPOSE

To report the results of arthroscopic lateral retinacular release without excision of the accessory fragment for treatment of symptomatic bipartite patella with a minimum 2-year follow-up.

METHODS

We retrospectively reviewed all cases of symptomatic type III bipartite patella confirmed by radiographs, computed tomography, and magnetic resonance imaging and treated with arthroscopic lateral release from 2005 to 2015. Patients with history of knee fractures or surgery, concomitant meniscal or anterior cruciate ligament (ACL) procedures, and severe arthritic changes of the patellofemoral joint were excluded. Patients were assessed by Kujala score, visual analog scale (VAS), Tegner Activity Scale (TAS), and time to return to sporting activities.

RESULTS

Ten patients (11 knees) were clinically reassessed after 69.6 ± 33.3 (range: 25-132; 95% confidence interval [CI]: 47.29-91.99) months from surgery. There was a significant improvement in Kujala (P < .05) and VAS scores (P < .05), and no differences were found between pre- and postoperative TAS scores (P > .05). No complications occurred during the follow-up period. All patients returned to sport after 42.3 ± 11.3 (range: 30-60; 95% CI: 34.71-49.84) days after surgery.

CONCLUSIONS

The arthroscopic lateral retinacular release of a symptomatic type III bipartite patella without excision of the accessory fragment allowed early return to sporting activities, with excellent symptom relief. Patients had significantly improved mean Kujala and VAS scores without a decrease in the mean TAS scores.

LEVEL OF EVIDENCE

Level IV, case series.

[Jumper's Knee]

Zusammenfassung. Sportliche Aktivitäten mit Sprungabläufen stellen für die Kniegelenke eine mechanische Herausforderung dar. Häufig projizieren sich chronisch auftretende, atraumatische Beschwerden auf den Patellaunterpol, welcher pathomorphologisch eine patellare Tendinopathie entspricht. Extrinsische und intrinsische Risikofaktoren können unterschieden werden. In der klinischen Untersuchung zeigt sich ein meist unauffälliges Knie mit einer Druckdolenz am kaudalen Teil der Kniescheibe beim Übergang zum Ligamentum patellae. In der Bildgebung ist sonografisch ein degenerierter Sehnenanteil der tiefen Patellarsehne zu erkennen, der magnettomografisch mit Hyperintensität des Hoffa-Körpers einhergehen kann. Abhängig von der klinischen Entwicklung wird das Jumper’s Knee nach Blazina Grad I–IV eingeteilt. Bis zu 90 % der Patienten können konservativ therapiert werden. Operativ stehen offene und arthroskopische Verfahren mit ordentlichem Resultat zur Verfügung.