Knee > Sinding-Larsen-Johansson Syndrome
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   Bracing and Immobilization

Home Recovery

Depending on your level of activity and on the degree of pain and discomfort you are experiencing from Sinding-Larsen-Johansson (SLJ) syndrome, your doctor may suggest that you wear a protective knee brace or a light cast. A patellar-stabilizing brace or an infrapatellar sling can take the tension off the kneecap, and a patellar-stabilizing brace with a pad that goes over the kneecap (patella) can often prevent pulling of the patellar tendon. Some athletes with mild symptoms use a patellar tendon strap, which is worn just below the kneecap. If you are going to be physically active, a padded knee sleeve, such as those used by wrestlers and basketball players, can help guard against direct blows or falls. For severe cases of SLJ in which pain has worsened or has not responded to other treatments, your doctor may recommend that you wear a cast that will immobilize your knee. This type of cast usually is cylindrical and made out of fiberglass or plaster over cotton padding, and stretches from the ankle to the thigh. This treatment usually lasts no more than six weeks. Another alternative is a knee immobilizer, which generally is made out of fabric and attaches to the leg with straps, which allows for removal to clean the skin or scratch an itch. Casts are sometimes better for children and teenagers because they cannot take them off at school, which assures that the knee is truly rested.

If you have had your knee immobilized in a brace or cast during treatment for Sinding-Larsen-Johansson (SLJ) syndrome, your rehabilitation is crucial to restoring leg strength and flexibility as well as preventing your condition from getting worse. Stretching is particularly important because what often happens during a growth spurt is that the quadriceps have not increased their flexibility in relation to the lengthening of the bone. Strengthening should focus on the quadriceps and hamstrings, and can include exercises such as straight-leg raises, wall slides, leg curls, and quadriceps contractions. These exercises can be done at home or under the supervision of a physical therapist. While doing these exercises, it is important to remember to go slowly and not to push yourself to the point where you feel pain. It is preferable to do more repetitions of each exercise rather than fewer repetitions with higher resistance. It may help to apply heat to the affected area for about 15 minutes before exercising or sports, to loosen up your muscles and tendons. After you finish, icing your knee and keeping it elevated can decrease pain and inflammation. After immobilization, it may take from one to three months to regain strength and flexibility. Exercises may be necessary for the entire length of time of the growth spurt in order to prevent recurrence.

It is probably unrealistic to expect to prevent Sinding-Larsen-Johansson (SLJ) syndrome, simply because it is related to natural growth spurts. But you can take steps to minimize its effects. Exercises that strengthen the quadriceps and hamstrings, such as straight-leg raises and leg curls, can prevent the condition from getting worse. Avoiding overuse is important, as is modifying the specific activity. In soccer, for instance, if you are taking all the free kicks, you may have to relinquish that role for a while. If you play an outside position, you could be moved to an inside position to lessen the amount of running required. If you are a gymnast who has developed SLJ from repetitive jumping, for example, you may have to modify or stop using dismounts in the early, acute phase of the disease. Occasionally, an athlete may have a foot problem that can contribute to SLJ. In this instance, custom-made shoe inserts (orthotics) may be effective in decreasing stress on the knee and lower leg. See your doctor for a complete evaluation.