Definition
Traction apophysitis of the lower pole of the patella
Epidemiology
Active adolescents aged 10 - 14
Repetitive overloading
Materne et al Scan J Med Sci 2022
- prospective study of 500 male youth soccer players
- 6% SLJ
Clinical
Activity related pain
Tenderness and lower pole of the patella
Xray
Fragmentation / calcification of inferior pole
Accessory ossicles inferior pole
Fragmentation / calcification of inferior pole
Accessory ossicle inferior pole
Medlar and Lyne Classification
- Stage I: Xray normal
- Stage II: Irregular calcifications inferior pole
- Stage III: Calcium coalesces into inferior pole
- Stage IVa: Reattachment and healing of ossification
- Stage IVb: Formation of separate ossicle
CT
Fragmentation / calcification of inferior pole
Accessory ossicle inferior pole
MRI
Inflammation inferior pole patella
Natural history
Self- limiting
Resolves with skeletal maturity
Nonoperative management
Options
Rest
NSAIDS
Physiotherapy
Operative management
Indication
Loose painful ossicle inferior pole patella
Technique
Open resection loose SLJ ossicle PDF
Arthroscopic resection of loose SLJ ossicle PDF
Midline incision
Split patella tendon
Excise ossicle