Laki-laki, 15 tahun, seorang pemain basket, datang dengan keluhan nyeri dilutut bagian depan, nyeri

hilang timbul sejak 3 minggu yang lalu, nyeri awal timbul saat pasien sedang bermain basket, nyeri
bertambah saat pasien jongkok, melompat dan berlatih olahraga, nyeri berkurang saat istirahat,
keterbatasan menekuk lutut, bengkak pada lututndan riwayat trauma disangkal.

A 15-year old, basketball player reports with symptoms of pain in the front of his knee that has been
continuous for three weeks. The pain began when the patient was playing basketball and increased
when he squatted, jumped, or exercised. Limited knee flexion, knee edema, and a history of trauma was
denied.

Pada pemeriksaan fisik inspeksi ditemukan pembekakan minimal pada lutut, pada palpasi terdapat nyeri
saat lutut dipegang, nyeri pada lutut saat fleksi, ekstensi, internal rotasi, eksternal rotasi lutut.
Ballottement test postif atau efusi cairan pada tempurung lutut, Patellar Grind Test positif atau nyeri,
Knee Extension Resistance Test positif atau kekuatan ekstensi menurun akibat nyeri bagian patella.

Pemeriksaan penunjang yang dilakuka yaitu lateral Radiographs showed minimally displaced distal
patellar ossicle and Sagittal MRI depicting distal pole fragmentation and edema.

On physical examination, there was minimal swelling of the knee, and palpation indicated pain when the
knee was held, as well as pain when the knee was flexion, extention, internal rotation, and external
rotation. Positive ballottement test or fluid effusion in the kneecap, positive patellar grind test or pain,
positive knee extension resistance test or decreased extension strength due to patellar pain are all
possible causes of patellar pain.

Lateral radiography revealed a minimally displaced distal patellar ossicle, while a Sagittal MRI showed
distal pole fragmentation and swelling.

Table 1. Rehabilitation Program

Duration 2 month
Frequency 3 times a weeks
Intensity 1-60 minutes per sessions
Quadriceps stretching and strengthening
Hamstring stretching and strengthening
Taping or bracing (patellar band)
Type
Modalities for Pain or inflammation (Transcutaneous Electrical Nerve
Stimulation/TENs)
Hip strengthening (Gluteus Medius)

Table 2. Outcome measures

Pre-intervention Post-intervention
Knee Flexion 60° 125°
Knee Extension 0° 0°
VAS 7 2
Quadriceps MMT 3 5

Discussion

Sinding Larsen Johansson (SLJ) Syndrome is caused by increased tension and pressure due to repetitive
traction by the patellar tendon on the lower pole of the patella (still partly cartilaginous in adolescents)
during contraction of the quadriceps muscle. The syndrome is seen in adolescents typically between 10
and 14 years of age, but most often in males who play sports

Pasien tersebut berusia 15 tahun dan seorang pemain basket, mengalami nyeri setelah bermain basket,
nyeri pada lutut depan terutama saat beraktivitas. Pasien diberikan rehabilitasi selama 2 bulan, pasien
dapat mengfleksikan lutut dan rasa nyeri berkurang.

The patient is 15 years old and a basketball player who is reporting pain in the front knee after playing
basketball, especially during activities. After two months of rehabilitation, the patient was able to flex
his knee and his discomfort was minimized.

In the acute painful phase, therapy is mainly rest and abstention from sports activity for at least 1-2
months, may be replaced by swimming and other sports which exert less pressure on the quadriceps
femoris muscle and had an intensive rehabilitation focusing on eccentric muscle strengthening exercise

Conclusion

This case study concludes that rehabilitation is effective in improving range of motion, decrease the pain
and patient ability to maximize activity