Since there is no universally agreed-upon "best" amount of femoral lengthening. What do you think based in your experience the best amount you advise for?
I think it’s highly individual based on the risk/reward you’re willing to go for.
Let’s say you have infinite money, or at least money is no issue. Then I would personally go for a modest amount like 4 cm on femurs, and then later 3 cm on tibias. This strategy would be to try and limit long term problems like ballerina that is caused by the Achilles’ tendon strain from the tibia lengthening, and also the duck ass from the strain on the IT band from the femur lengthening.
But in a realistic scenario money is the main issue. So if you can’t save up forever then maybe it is a better strategy to go for just femurs and then lengthen 6 cm on femurs and then just deal with the duck ass through lots of PT and hope you can walk long distances / run one day without any issues.
Then again maybe the increased risk from lengthening 6 cm femur instead of 4 cm is actually not that high. But this is the issue I find the most interesting about LL. How significant is the total lengthening amount and the lengthening speed for long term recovery of athletic ability? I wish we had more research on this.
Quote from: TheDream on May 23, 2023, 09:46:35 PMI think it’s highly individual based on the risk/reward you’re willing to go for.
Let’s say you have infinite money, or at least money is no issue. Then I would personally go for a modest amount like 4 cm on femurs, and then later 3 cm on tibias. This strategy would be to try and limit long term problems like ballerina that is caused by the Achilles’ tendon strain from the tibia lengthening, and also the duck ass from the strain on the IT band from the femur lengthening.
But in a realistic scenario money is the main issue. So if you can’t save up forever then maybe it is a better strategy to go for just femurs and then lengthen 6 cm on femurs and then just deal with the duck ass through lots of PT and hope you can walk long distances / run one day without any issues.
Then again maybe the increased risk from lengthening 6 cm femur instead of 4 cm is actually not that high. But this is the issue I find the most interesting about LL. How significant is the total lengthening amount and the lengthening speed for long term recovery of athletic ability? I wish we had more research on this.
I'd say even if money is not an issue avoiding two surgeries (4 nails) would still be a smarter strategy for the long term but i could be wrong, but with that in mind, the patient would be limited to the amount lengthened (best cases i saw from one surgery are usually under 6cm femurs and the full recovery time is usually less than a year) which for me is a far better deal.
But realistically speaking, most of people in this forum would find anything under 6cm extremely underwhelming.
Quote from: Hebi on May 23, 2023, 09:55:45 PM I'd say even if money is not an issue avoiding two surgeries (4 nails) would still be a smarter strategy for the long term but i could be wrong, but with that in mind, the patient would be limited to the amount lengthened (best cases i saw from one surgery are usually under 6cm femurs and the full recovery time is usually less than a year) which for me is a far better deal.
But realistically speaking, most of people in this forum would find anything under 6cm extremely underwhelming.
Yes you are absolutely correct. In this scenario I imagine waiting until the rods, nails etc are out of the femur before starting tibia, but still you have undergone 2 surgeries instead of 1, so maybe my assumption that this fully heals is not the case, and it is best to do 1 surgery but lengthen more.
Again, this is the part I find most interesting. Wish we had more LL’ers that have healed who could give us more insight into their athletic recovery long term. But I imagine most people who have done that just want to forget all about height and LL and move on so they don’t come back.
Isn't the answer exactly 8? Why make it a cut off on 2 different options
IMO:
5-6cm for Femurs is my own opinion.
I am getting mine lengthened, and i am not going above this ballpark. 6cm is probably the maximum i'm going to go for and only with the garuentee of a proper Z cut ITB release beforehand.
depends on the individual
Maximum Overdrive: the distraction (6-10cm for the vast majority) one can achieve without getting joint contractures, compartment syndrome, and permanent nerve damage.
maintain inconspicuous proportions: the amount that keeps the crural index ≥0.72, ape index ≥0.96, and sh:h ≥0.49. the first two can be modified with tibiae and humeri lengthening.
preserve athletic ceiling and biomechanics: ≤6cm and crural index ≥0.72
the possibility of additional tibial lengthening should be considered before setting an expectation.
Quote from: sixfootandhalf on May 24, 2023, 09:12:21 AMIMO:
5-6cm for Femurs is my own opinion.
I am getting mine lengthened, and i am not going above this ballpark. 6cm is probably the maximum i'm going to go for and only with the garuentee of a proper Z cut ITB release beforehand.
And your opinion sounds dumb. It's obviously dependent person by person but if Paley, and the rest of the USA doctors allows for 8cm, then that is the safe answer.
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