Sinding-Larsen-Johansson Disease: Analysis of the Associated Factors in the Largest Cohort to Date

BACKGROUND: Sinding-Larsen-Johansson Disease (SLJ) is an overuse disorder seen in skeletally immature adolescents, on the same spectrum as Osgood-Schlatter disease (OSD). SLJ is caused by weakness at the tibial tubercle apophysis, leading to stress at the patellar apophysis. Like other overuse disorders, the mechanism behind this is thought to be quadriceps tightness. However, there is a paucity in research done on SLJ, with the vast majority of research being case reports. To our knowledge, we are able to present the largest cohort to date of 40 knees in 29 patients. HYPOTHESIS/PURPOSE: Our aim was to utilize this large cohort to look at the demographics, clinical presentation and radiographic evidence of the disease, and begin to evaluate trends in SLJ. METHODS: A case control study was conducted utilizing pediatric patients from our institution seen between 2013 and 2019 diagnosed with SLJ. The following variables were collected: demographics, clinical presentation, sporting activities, radiological evidence of effusion and fragmentation, and posterior tibial slope. RESULTS: A total of 40 knees in 29 patients were analyzed. 38% (11/29) of patients presented with bilateral disease. The mean age of presentation was 12.1 ± 1.4 years. 62% of patients were male, with an average BMI of 19.7 ± 2.9. 41% presented with concomitant overuse injuries, predominantly OSD (31%) and Sever’s Disease (7%). All of the patients played sports; basketball and soccer were the most common (27.6% each). While some patients presented with symptoms that forced them to modify their activity level (35%), the vast majority (65%) had symptoms considered “mild,” with no changes to daily activities. Most patients (96%) had stable ligamentous exams. 100% of x-rays showed evidence of an effusion. The average posterior tibial slope was 8.2 ± 2.1°, with an average fragmentation of 0.8. We found no correlation between posterior tibial slope and severity of symptoms (p = 0.75) or between posterior tibial slope and fragmentation of the tibial apophysis (p = 0.70). CONCLUSION: Most patients with SLJ present with unilateral disease. Additionally, close to half of patients presented concomitantly with other overuse disorders. These patients are consistently athletes, but the disease predominantly did not cause a change in daily activities. We also found that patellar effusion was universally present in our cohort. More work needs to be done to determine factors associated with SLJ, but we believe this is the strongest and largest analysis to date of the patients presenting with this disease.