yogabook / pathologie / sinding-larsen-johansson desease

Sinding-Larsen-Johansson disease (SLJS) / Larsen-Johansson disease

Definition of

Juvenile inflammation of the patellar ligament at the caudal patellar pole (apex patellae) with a tendency to detach a piece of the patella, which then necrotizes. Similar to the more common Osgood-Schlatter disease on the tibial tuberosity, ossicles can form which rub painfully against the tendon. The peak age is 10 – 14 years, the syndrome often occurs in growth spurts, unilaterally or bilaterally. M:W 2.7:1 to 3:1. Apart from the fact that the patellar ligament is a ligament and not a tendon, the disorder is similar to insertional tendinopathy. Small foci of inflammation develop, which later calcify. According to Roels, a distinction is made between 4 degrees:

1. Pain after exercise
2. Pain on exertion, which subsides with prolonged exertion(initial pain), the pain returns after exertion
3. Pain in everyday situations, uninterrupted pain on exertion, pain at rest
4. Tear of the patellar ligament, necrosis of the patella

ICD M92.4

Cause

1. Overuse with repeated microtrauma (high load in eccentric contraction) due to landing during jumping and abrupt stop and go maneuvers

Predisposing

1. Shortening of the quadriceps
2. Sports: basketball, volleyball, long jump and high jump, tennis, soccer, skiing, weightlifting
3. Starting or intensifying one of the risky sports or
4. idiopathic ligament weakness
5. Axial and static defects of the spine, pelvis or lower extremities; foot deformities
6. Shortening of the relevant knee muscles: quadriceps, hamstrings, gastrocnemius

Diagnosis

1. Sono: detects altered tendon
2. X-ray: shows bone changes
3. MRI: Bone edema at the caudal patellar pole

Symptoms

1. Pressure soreness
2. Exercise-induced pain
3. Pain subsides spontaneously within hours of exertion/overload
4. Possible signs of inflammation
5. later: start-up pain, which then disappears and reappears after prolonged exertion
6. Painful extension of the knee joint against resistance
7. Pain triggered by: Squats, running, sprinting, climbing stairs, jumping
8. Grade 1 and 2: improvement at rest

Complications

1. Rupture of the patellar ligament
2. Necrosis at the caudal patellar pole, avulsion fracture
3. Chronification
4. Treated in good time: good prognosis if the patellar ligament is not overloaded
5. Impairment of night-time sleep, resulting in sleep disorders, tiredness, general irritability
6. Continued overloading can lead to irreversible damage to the knee joint
7. Detachment of bone pieces(ossicles)

Therapy

1. Ossicles can be an indication for surgery
2. symptomatic, conservative, protracted
3. Avoiding the triggering of pain
4. For acute pain: cooling, NSAIDs
5. PT
6. Stretching and strengthening the quadriceps and hamstrings
7. TENS (electrostimulation), iontophoresis, shock wave therapy
8. only if conservative treatment is resistant: surgery

Asana practice

In addition to adequate load reduction, which may mean temporarily discontinuing sports that trigger the injury, it is particularly important to bring the muscle system that moves the knee joint in a sagittal direction into good function: the hamstrings as the flexor of the knee joint and the quadriceps as the extensor of the knee joint.

Asanas

Asanas in 811: Dehnung des Quadrizeps
Asanas in 812: Kräftigung des Quadrizeps
Asanas in 816: Dehnung des Rectus femoris
Asanas in 817: Kräftigung des Rectus fem oris
Asanas in 721: Dehnung der Ischiocruralen Gruppe
Asanas in 722: Kräftigung der Ischiocruralen Gruppe