Does your child love to play sports? Does it seem like he never has a day off to run, jump, and play? If such an active child suddenly experiences knee pain, it is normal for you as a parent to feel very scared. Especially if it is pain in the lower part of the knee, it could be a condition called Sinding-Larsen-Johansson Syndrome , which we are talking about today. Don't worry, let's talk about this in detail.
What is Sinding-Larsen-Johansson Syndrome?
Simply put, Sinding-Larsson-Johansson syndrome (SLJ) is a condition in which your child's kneecap (patella) is a hard tissue called the patellar tendon that connects the kneecap to the shinbone (tibia). Specifically, the problem occurs where this tendon attaches to the bottom end of the kneecap. This is also a condition called osteochondritis , which is a problem that occurs in children's growing bones.
Think about it, your child's bones are still growing. Especially in joints like the knee, there are parts called "growth plates." These are what help the bones grow. In SLJ, what happens is that the growth plate, which is located at the inferior pole of the patella, is damaged.
This condition is most often seen in children between the ages of 10 and 14 who play sports or are very active. This is because children's bodies develop rapidly at this age, and they are also very involved in sports.
Why does this happen? What are the reasons?
The main cause of this is overuse of the knee . Think of the patellar tendon as a rubber band. It holds the kneecap and shinbone together and helps them move properly. When children run, jump, or kick (for example, when playing soccer), the large muscles in the front of their thighs (the quadriceps muscles) are activated. When these muscles contract, a strong pull is applied to the kneecap through the patellar tendon.
When this pulling continues, repeated, and repetitive , it can cause microtraumas where the tendon attaches to the kneecap. These small injuries accumulate and eventually lead to SLJ.
For example, imagine that your daughter is on the school netball team. She practices for hours every day, jumping and running, because there is a tournament coming up. Or your son plays cricket, runs fast and bowls, and puts weight on his knees when hitting the bat. These types of activities can cause SLJ.
In general, SLJ can be caused by things like:
- Running often.
- Jumping up frequently.
- Kicking sports (like football, karate).
- Any activity that puts a lot of sustained force on the legs and knees.
What is the difference between SLJ and Osgood-Schlatter disease?
You may have also heard of Osgood-Schlatter disease. The two are very similar. Both are caused by damage to the patellar tendon in active, growing children. The causes, symptoms, and even treatments are very similar.
The main difference is where the tendon is damaged.
- In Sinding-Larsson-Johansson syndrome (SLJ), the damage occurs at the top of the tendon, that is, where the tendon starts at the kneecap (patella).
- In Osgood-Schlatter disease, damage occurs to the lower part of the tendon, that is, where the tendon attaches to the shin bone (tibia).
It can be difficult to tell the difference between the two. The good news is that both are treated with rest and anti-inflammatory medications, so the treatments are very similar. Your doctor will examine your child and tell you whether it is SLJ or Osgood-Schlatter.
Who is more likely to develop this?
As we mentioned earlier, SLJ is most common in children between the ages of 10 and 14 , especially those who play sports. There is a reason for this age range. This is when children are going through growth spurts. When bones, muscles, and tendons are all changing rapidly at the same time, joints like the knees can be put under extra stress.
Some studies have shown that children with cerebral palsy have a slightly higher risk of developing SLJ.
Does it happen to adults too?
SLJ is very rare in adults. In fact, if you are over 15 years old and have these symptoms, it is likely to be another condition, such as "Jumper's Knee" (patellar tendinopathy). There are many other causes of knee pain in adults. Therefore, if you have new pain, especially after strenuous physical activity, it is best to see a doctor.
How common is this situation?
SLJ is a very common condition , and it is a common cause of knee pain, especially among active young children.
What effect does this have on the child's body?
This can be very painful for the child. However , SLJ does not have any long-term effects on the child's health or prevent them from doing the activities they enjoy . The child will need to rest and avoid the sport or activity that caused the condition until the patellar tendon heals, which can take several weeks to several months. However, once healed, they can return to their normal activities without any long-term effects.
What are the symptoms of this?
The main symptoms of Sinding-Larsson-Johansson syndrome are:
- A sharp pain just below the child's knee, just above the shin. This is the main symptom.
- Swelling.
- Tenderness around the knee.
- It becomes difficult to bend the knee normally.
If your child is experiencing these symptoms, especially if he or she is a sportsperson, you should consider SLJ.
How does a doctor diagnose this?
When you take your child to a doctor, he/she will first do a physical exam of the child's knee and hip. He/she will ask questions such as when the pain started and how it is getting worse.
In addition, some imaging tests may be performed to confirm the SLJ status and to check for other injuries (such as fractures).
What are these tests?
- X-ray: An X-ray can be used to check for fractures in the kneecap, tibia, or other bones. It can also check for stress fractures, which are especially common among athletes.
- MRI (Magnetic Resonance Imaging): An MRI can provide a complete picture of the knee and the surrounding area. It can also check for thickening of the patellar tendon due to injury.
- Ultrasound: An ultrasound test can look at how blood flows through the muscles and connective tissue around the knee.
After these tests, the doctor will be able to tell for sure whether your child has SLJ or something else.
How is SLJ treated?
The main and best treatment for Sinding-Larsson-Johansson syndrome is rest and stretching of the quadriceps muscles in the front of the thigh . Until the child's patellar tendon heals, he or she will need to stop playing the sport or games that caused the injury.
Most children will need to stay away from sports for a few weeks to a few months. The length of time depends on the severity of the injury at the time of injury. As the child recovers, they may be able to switch to other activities that put less stress on the knee (such as swimming) instead of the sport they were playing.
Here are some things you can do to reduce pain and swelling in the short term:
- Ice application: Place ice wrapped in a cloth on the painful area of your knee for 15-20 minutes several times a day.
- Painkillers: On medical advice, you can take NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen. These reduce pain and swelling.
Important: Always talk to your doctor before starting, stopping, or changing the dosage of any medication for your child. Do not give your child NSAIDs for more than 10 days without your doctor's approval.
Will surgery be necessary?
It is very rare for a child to need surgery to treat Sinding-Larsson-Johansson syndrome. Even in the most severe cases, doctors usually recommend other, less invasive treatments, such as physical therapy, before recommending surgery for a child or young person.
Sometimes, adults diagnosed with SLJ may need to undergo knee arthroscopy to repair their patellar tendon.
Do NSAIDs have side effects?
Yes, NSAIDs can cause some side effects. That's why they should be used only as directed by your doctor. Some of the side effects include:
- Bleeding.
- Stomach ulcers.
- Stomach pain.
- Digestive system complications.
How quickly will the child feel better after treatment?
When taking NSAIDs, the pain usually subsides and the child begins to feel better within about an hour. The same goes for ice.
However, this pain relief does not mean that the child's patellar tendon has completely healed . Rest and avoiding the activity that caused the SLJ condition are the most important parts of the child's treatment.
Follow the doctor's instructions exactly. Depending on your child's condition, the doctor will tell you how long it will take for him to recover.
How can I reduce the risk of my child getting SLJ?
You can help prevent your child's patellar tendon from getting damaged in the first place. One of the best ways to do this is to give your child enough rest and recovery time between sports seasons.
More children and young people are now being diagnosed with SLJ than ever before. A major reason for this is that they train or play the same sport year-round (specializing in one sport) . When many children try to specialize in one sport or activity, their bodies don't get enough time to rest and recover. To protect themselves from not only SLJ, but all other disorders, it's best to prevent children from specializing in one sport until their late teens.
What should you do to stay safe from SLJ?
The best way to prevent Sinding-Larsson-Johansson syndrome is to regularly stretch the quadriceps muscles . The more flexible your child's legs are, the less stress they will put on their tendons.
In general, it's a good idea to follow these steps to reduce the pressure on the patellar tendon:
- Stretching before and after playing sports.
- Resting and taking breaks.
- "Playing through the pain" is never a good idea! If you feel pain, you should stop and rest.
What to expect if your child has SLJ?
If your child is diagnosed with SLJ, expect them to stay away from sports and strenuous physical activity for a while . SLJ is a temporary condition, but it takes time for the tendon to heal.
How long will this last?
How long Sinding-Larsson-Johansson syndrome lasts depends on the severity of the initial damage to the child's patellar tendon. Pain and swelling may subside within a few days or weeks. However, children may need to stay away from sports for several months to prevent long-term damage to the knee.
Can the child go to school?
Your child does not need to stop going to school while they are recovering from SLJ. To avoid putting pressure on the knee until it heals, ask your child's doctor if they need to take a break from physical education (PE/PT) classes .
What is the outlook for this situation?
Sinding-Larsson-Johansson syndrome is a temporary condition . However, it can be difficult for children to stop playing a sport they love for a while. Make sure your child understands what they need to do to help their body rest, recover, and heal, and why they need to stay away from the sport or activity that caused their SLJ condition for a while.
When should you see a doctor?
If your child has new knee pain, especially if it's accompanied by swelling, see a doctor right away . The doctor can help you determine what's causing your child's pain, whether it's SLJ or something more serious, like a fracture.
What questions should you ask the doctor?
When you go to the doctor with your child, don't forget to ask these questions:
- What tests should my child have?
- How long should a child stop playing ?
- Is this Sinding-Larsson-Johansson syndrome or Osgood-Schlatter disease?
- What stretches are there that can help prevent Sinding-Larsson-Johansson syndrome in the future?
Finally, things to remember (Take-Home Message)
It's normal for a parent to feel scared when a child is in pain. Especially when it involves a joint injury, there is concern about the long-term effects.
The good news is that Sinding-Larsen-Johansson Syndrome is a temporary condition that will not affect the child's knees in the future.
Even if your child has to miss a season of their favorite sport, make sure it's worth it because it's part of their recovery. With proper rest and following your doctor's instructions, your child will recover quickly and get back to doing the things they love!
` Sinding-Larsen-Johansson Syndrome, knee pain, pediatric knee disorders, sports injuries, patellar tendon, herniated disc, Osgood-Schlatter
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