Trauma & Sports

Sinding-Larsen-Johansson: Kneecap Pain in Young Athletes

Pain at the base of the kneecap: Sinding-Larsen-Johansson syndrome is an apophysitis typical of ages 10-14.

Updated: September 2026·Medically reviewed by Dr. Daniele Priano

Quick Answers

What is the difference between Sinding-Larsen and Osgood-Schlatter?
They involve traction at different sites: SLJ affects the tendon attachment at the developing lower patellar pole, whereas Osgood-Schlatter affects the tibial tuberosity apophysis. Some management principles overlap, but diagnosis, course and exercises are individual.
How long does it last?
Duration varies and cannot be predicted by one time window for everyone. Symptoms may fluctuate with growth and sporting load. Pain, function and clinical course matter more than the calendar when deciding progression and return to sport.
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Sinding-Larsen-Johansson syndrome (SLJ) causes pain at the lower pole of the kneecap, where the patellar tendon attaches. Repetitive traction affects the developing patellar pole, often in young athletes. It differs from Osgood-Schlatter, which affects the tibial tuberosity further down.

Running, jumping and stairs may provoke pain. The outlook is generally favourable, but permanent resolution cannot be promised at a particular age or when a “growth plate closes”.

Activity is adjusted to symptoms and function, with selected exercises and no forced painful stretching or strengthening. Sudden pain after trauma, marked swelling or inability to straighten the knee requires urgent assessment for other injuries, including fractures of the patellar pole.

Assessment and treatment

When to seek evaluation

  • Pain at the base of the kneecap during jumping or running
  • Pain worsening going up/down stairs
  • Tenderness at the lower pole of the kneecap
  • Pain after intense sports activity
  • Localized swelling at the base of the kneecap

What is evaluated

  • Palpation of the inferior patellar pole
  • Pain with resisted quadriceps contraction
  • Muscle flexibility assessment (quadriceps, hamstrings)
  • Differential diagnosis with Osgood-Schlatter and patellar tendinopathy
  • X-ray or ultrasound in selected cases

Treatment options

  • Sporting load modification according to symptoms and function
  • Exercises and physiotherapy selected after distinguishing the presentation from patellar tendinopathy, Osgood and other causes of anterior knee pain
  • Symptom-relief measures or supports only when useful in the individual case
  • Progressive return to running, jumping and sport when required tasks are again tolerated

Frequently Asked Questions

What is the difference between Sinding-Larsen and Osgood-Schlatter?▼
They involve traction at different sites: SLJ affects the tendon attachment at the developing lower patellar pole, whereas Osgood-Schlatter affects the tibial tuberosity apophysis. Some management principles overlap, but diagnosis, course and exercises are individual.
How long does it last?▼
Duration varies and cannot be predicted by one time window for everyone. Symptoms may fluctuate with growth and sporting load. Pain, function and clinical course matter more than the calendar when deciding progression and return to sport.
Can my child continue playing sport?▼
It depends on symptom severity and the required tasks. Neither automatic continuation nor complete rest is appropriate for everyone: load is modified and provoking tasks are temporarily stopped when pain or limping is significant, followed by progressive return.
Does it leave permanent effects?▼
The outlook is generally favourable, but freedom from residual symptoms cannot be guaranteed for every child. Persistent pain or an atypical course requires reassessment.

Other Juvenile Osteochondroses

Osteochondroses are a family of growth-related conditions. Learn about the others:

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Osgood-Schlatter(Knee)
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Sever(Heel)
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Köhler(Foot)
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Freiberg(Forefoot)
🦶
Iselin(Outer foot)
💪
Panner(Elbow)
Complete guide to juvenile osteochondroses →

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.