Sinding-Larsen’s disease: Causes, Symptoms, and Treatment

The disease known as Sinding-Larsen’s disease is an extremely painful inflammatory reaction in the area of the knee joint.

The inflammatory processes typical of Sinding-Larsen’s disease have their origin in the patellar tendon (patellar tendon, tendon of the quadriceps muscle). They manifest themselves mainly at the tip of the patella. As the inflammatory processes spread, one or more pieces of bone may become detached. The direct consequence is often the development of pronounced bone necrosis. For this reason, the actual inflammatory disease Morbus Sinding-Larsen belongs to the group of osteonecroses (diseases in which bone parts die-off).

The main number of affected patients are young people. Sinding-Larsen’s disease occurs more frequently in athletes. A direct comparison between women and men shows that there are significantly more male patients among those affected.

You may also be interested in Torn Patella Tendon: Causes, Symptoms, and Treatment

Causes of Sinding-Larsen’s disease

The cause of Sinding-Larsen’s disease appears to be chronic overloading of the kneecap. More precisely, long-term loading of the affected knee joint leads to an increase in the strain on the tendons and the bone transition in the area of the tip of the patella.

Sinding-Larsen’s disease occurs more frequently in people who expose their patellar tendon to particularly heavy, unusual, and repeated tensile stress. Furthermore, a distinction is made between internal and external factors that influence the causes of Sinding-Larsen’s disease.

The leading cause of this bone disease appears to be a frequently occurring maximum stress on the tendon of the large front thigh muscle (musculus quadriceps). According to experts, such maximum stress is particularly frequent in jumping sports. For this reason, basketball and volleyball players, in particular, have an increased risk of contracting Sinding-Larsen’s disease. Besides, many cases of Sendling-Larson’s disease can be observed in athletes who practice long and high jump.

However, it is not only the maximum load on the patellar tendon that plays a role in the development of the disease. Especially the lack of habituation to such a strain of the tendon seems to play a decisive role. For this reason, especially beginners of the risky sports are particularly at risk of contracting Sinding-Larsen’s disease.

Although the risk of developing patellar necrosis is particularly high in the sports mentioned above, more cases of Sinding-Larsen disease can be observed in patients who do less strenuous activities. A definite risk therefore, also exists for tennis players, weightlifters, cyclists, and joggers. In addition to these external factors, so-called “internal risk factors” for the development of patellar necrosis have now also been identified. According to this, people with congenital or acquired high patella (technical term: patella Alta) are particularly at risk. Furthermore, reduced elasticity of the muscles adjacent to the knee joint is believed to promote the development of the disease. A hereditary (genetic) component in the development of Sinding-Larsen’s disease could also not be excluded.

Read more about Patella fracture: Causes, Symptoms, and Treatment

Symptoms of Sinding-Larsen’s disease

The symptoms of Sinding-Larsen’s disease are quite general and can be assigned to several diseases of the knee joint. For this reason, a specialist should be consulted urgently, and a diagnosis sought if the symptoms in the area of the knee persist.

Patients suffering from Sinding-Larsen’s disease usually report severe pain in the affected knee. In many cases, the exact location of this pain can be assigned to the tip of the kneecap in the early stages. These pains are described as unusually pronounced and stressful, especially after a physically demanding situation. Depending on the extent and stage of the disease, the typical symptoms of Sinding-Larsen’s disease can disappear after a short warm-up phase and only reappear after the end of sporting activity. Patients suffering from advanced Sinding-Larsen’s disease, however, usually experience significant pain in the area of the patella tip, both at rest and during periods of stress. Also, redness or swelling of the affected knee may occasionally occur.

Classically, Sinding-Larsen’s disease is divided into four clinical grades according to its severity:

  • Pain only occurs after the end of the load.
  • At the beginning of the load, there is considerable pain. These disappear during the load and reappear after the end.
  • Pain persists (at rest and under stress)
  • A tear of the patellar tendon occurs

Want to know more about Cartilage damage in the knee: Symptoms, and Treatment?

Diagnosis

The diagnosis of Sinding-Larsen’s disease is divided into different steps:

In the beginning, there is usually a comprehensive doctor-patient consultation (anamnesis), during which the attending physician discusses the existing symptoms. Besides, the patient’s lifestyle (sports, etc.) and possible previous illnesses also play a decisive role.

Afterward, the attending physician will carry out a physical examination. During this examination, not only the aching knee is assessed but also all adjacent joints and the healthy side of the body. Patients suffering from Sinding-Larsen’s disease usually experience a strong pressure pain above the tip of the lower patella during this physical examination. In addition, patients suffering from Sinding-Larsen’s disease can only fully extend the affected knee in pain.

If the suspicion of Sinding-Larsen’s disease is confirmed after the first diagnostic steps, an ultrasound examination of the knee is usually performed first. In severe or pronounced cases, changes in the bone structure can already be imaged in the ultrasound. However, a nuclear spin examination (MRT) must be carried out for a reliable diagnosis. Only with the help of MRI can the extent of the disease be reliably assessed and possible therapeutic steps weighed up.

Please also read our topic Jumpers Knee: Causes, Symptoms, and Treatment

Therapy of Sinding-Larsen’s disease

The treatment of Sinding-Larsen’s disease is divided into non-operative (conservative) and operative measures. Depending on the extent and stage of the disease, a different type of treatment is particularly suitable for promoting the regeneration of the affected knee.

Initially, however, it is crucial for all affected persons to spare the corresponding knee and to avoid further overloading. For this purpose, in most cases, a temporary sports leave granted immediately after the diagnosis. The most frequently performed conservative forms of therapy for patients suffering from Sinding-Larsen’s disease are the application of warm or cold compresses and so-called electrostimulation (synonyms: iontophoresis, TENS). Furthermore, in many cases, enormous treatment successes could be achieved by the targeted application of ultrasound. In addition to a reduction in the load on the affected knee, physiotherapeutic exercises and manual therapy should be carried out at regular intervals.

Furthermore, the so-called shock wave treatment is considered a suitable method in the therapy of patients suffering from Sinding-Larsen’s disease. In general, all described methods have a common therapeutic goal: the regeneration of the tendon attachment should be stimulated by local metabolic activation and an increase in regional blood circulation. Also, the tensile forces acting on the patella should be reduced by loosening the thigh muscles. Furthermore, the regular application of anti-inflammatory ointments or the intake of non-steroidal anti-rheumatic drugs is considered to be particularly promising in the treatment of Sinding-Larsen’s disease.

Homeopathy pursues various therapeutic approaches in the sense of injecting natural substances such as Traumeel or Zeel around the tendon sliding tissue. Just by applying the conservative treatment methods alone, the course of the disease in Sinding-Larsen’s disease can, in most cases, be limited, and the regeneration of the affected knee can be successfully stimulated. Only in about 10 percent of the patients, no success can be recorded despite a correspondingly long therapy.

In precisely these cases, surgical intervention is considered the only possibility of cure. At present, patients with Sinding-Larsen’s disease are treated with various procedures that can be performed either individually or in combination. In order to reduce the stress in the area of the patella tip, the visual gliding tissue can be removed. Besides, denervation of the tendon environment, tendon loosening at the tip of the patella, and removal of the dead bone tissue are considered particularly useful.

You may also be interested in Knee joint arthrosis: Causes, Symptoms, and Treatment

Prognosis

The prognosis of Sinding-Larsen’s disease is excellent if it is diagnosed early, and therapy is initiated quickly. However, affected patients must avoid excessive stress on the tip of the patella even after treatment has been completed.

Read more about Patellar Dislocation: Causes, Symptoms, and Treatment 

Prevention of Sinding-Larsen’s disease

Sinding-Larsen’s disease is a classical disease that is due to damage caused by the overloading of the kneecap. For this reason, Sinding-Larsen’s disease can also be easily prevented in athletes by following various measures. Probably the most effective way of prevention is to do various muscle stretching exercises before the sport. In addition, especially people who participate in sports that are considered typical for the occurrence of Sinding-Larsen’s disease should warm-up well before starting physical activity.

Since this type of bone necrosis can be observed, especially in people who have only recently started to practice jumping sports, the slow increase in knee load is considered an effective preventive measure. Athletes with a tight training schedule should always allow sufficient time for regeneration outside of the units. In this way, the hardening of the thigh muscles and excessive strain on the tip of the kneecap can be prevented.

Patients with known deformities of the ankle, knee, or hip joints should have suitable sports insoles fitted by an orthopedic specialist. In addition, every athlete should take the first warning signs of the body severely. In case of pain in the knees or hips, the activity level should be reduced immediately, and a specialist should be consulted if necessary.

You can also check other articles about Knee pain and conditions, causes and treatment

Resources

  1. Perry J, Burnfield JM. Gait analysis : normal and pathological function. Thorofare, NJ: SLACK; 2010. [Google Scholar]
  2. Tashman S, Anderst W. In-vivo measurement of dynamic joint motion using high speed biplane radiography and CT: application to canine ACL deficiency. Journal of biomechanical engineering. 2003;125:238–45. [PubMed] [Google Scholar]
  3. Anderst W, Zauel R, Bishop J, Demps E, Tashman S. Validation of three-dimensional model-based tibio-femoral tracking during running. Medical engineering & physics. 2009;31:10–6. [PMC free article] [PubMed] [Google Scholar]
  4. Goyal K, Tashman S, Wang JH, Li K, Zhang X, Harner C. In vivo analysis of the isolated posterior cruciate ligament-deficient knee during functional activities. The American journal of sports medicine. 2012;40:777–85. [PubMed] [Google Scholar]
  5. Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. Journal of biomechanical engineering. 1983;105:136–44. [PubMed] [Google Scholar]
  6. Anderst WJ, Les C, Tashman S. In vivo serial joint space measurements during dynamic loading in a canine model of osteoarthritis. Osteoarthritis Cartilage. 2005;13:808–16. [PubMed] [Google Scholar]
  7. Bender R, Lange S. Adjusting for multiple testing--when and how? Journal of clinical epidemiology. 2001;54:343–9. [PubMed] [Google Scholar]
  8. Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1:43–6. [PubMed] [Google Scholar]
  9. Frank CB, Beveridge JE, Huebner KD, Heard BJ, Tapper JE, O’Brien EJ, et al. Complete ACL/MCL deficiency induces variable degrees of instability in sheep with specific kinematic abnormalities correlating with degrees of early osteoarthritis. J Orthop Res. 2012;30:384–92. [PubMed] [Google Scholar]
  10. Anderst WJ, Tashman S. The association between velocity of the center of closest proximity on subchondral bones and osteoarthritis progression. J Orthop Res. 2009;27:71–7. [PMC free article] [PubMed] [Google Scholar]
  11. Farrokhi S, Voycheck CA, Klatt BA, Gustafson JA, Tashman S, Fitzgerald GK. Altered tibiofemoral joint contact mechanics and kinematics in patients with knee osteoarthritis and episodic complaints of joint instability. Clin Biomech (Bristol, Avon) 2014;29:629–35. [PMC free article] [PubMed] [Google Scholar]
  12. Drummond C, Israelachvili J, Richetti P. Friction between two weakly adhering boundary lubricated surfaces in water. Phys Rev E Stat Nonlin Soft Matter Phys. 2003;67:066110. [PubMed] [Google Scholar]

Leave a Comment