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Posted on Dec 10, 2013, 8:09 pm
#11
There is no confusion, just people with poor comprehension and others taking quotes out of context. Franz was very clear honestly. Undoubtedly some will read this thread and make massive life changing decisions, sorry for wanting to make the information to be accurate? Didn't really mean the post to be over hostile though.


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Posted on Dec 11, 2013, 12:09 am
#12
The point is that there are some permanent "complications" after LL.
Question is: how can we prevent/treat it? I wonder why it's the knee, gotta do some more research.
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Posted on Dec 11, 2013, 3:42 am
#13
Quote from: Doflamingo on December 11, 2013, 12:09:18 AMThe point is that there are some permanent "complications" after LL.
Question is: how can we prevent/treat it? I wonder why it's the knee, gotta do some more research.

Doflamingo,

The patellar tendon is split in order to insert IM nails into the knees. This is an important tendon for knee flexion, and doesn't always heal properly from the operations to insert and remove nails. Dr. Franz kindly provided us the statistics regarding the percentage of patients who end up with permanent knee pain.

Unfortunately, there is no other way to insert a lengthening nail into the tibia. So if you do, LON, LATN, or internal lengthening you run a high risk of being stuck with permanent knee pain. It's just the harsh reality of LL, and, unlike the old forum, here we believe that it's best to disclose this BEFORE a prospective lengthener jumps the gun and gets nails inserted.

Your best bet to minimize your chances of permanent knee pain is to do external fixation ONLY and not remove the frame until your bones have fully consolidated. You should do this with a weight-bearing frame (like the Taylor Spatial) and walk and stand, or your muscles will completely atrophy during lengthening, and you run the risk of getting severe ballerina foot. Unfortunately, given your particular time constraint of 2-3 months to do LL, externals-only may not be a feasible option, and you may have to run the risk of getting permanent knee pain or forego LL altogether. The choice is ultimately yours, but please take the time to become as informed as possible.

Best wishes,

Tall
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Posted on Dec 11, 2013, 10:56 am
#14
Thanks Tall.
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Posted on Dec 11, 2013, 1:52 pm
#15
From the old forum, the Dictator deleted a post from Shorty who request for removal of his LL photos, they ignored patient rights to privacy. Screw them!

Questions from Member

1) If you do LL in your tibias, will this somehow also have impact on your upperleg (for eg: shortening in the muscle hamstring)?
2) Is LL the cause of x and o legs? If yes, how to treat or prevent it?
3) Pinbending is caused by standing; let's say I'll only do 5cm but I'd rather not have any pinbending and yet I want the best for my soft tissues, what should I do? I was thinking of simply stretching in bed, or isn't that enough? Any suggestions please.
4) Will take supplements make you heal faster? (multivitamin, calcium, protein, ...)? I'm planning to take them (limited).
5) Are ballerinas and duck-asses treatable on a natural way (no operation) after LL? Or is it forever?
6) How do you take showers with external devices on your legs? Cover them with plastic (wouldn't the water come it?)
7) After frame removal, how long do you have to stay in bed before walking?
8-) Do you lose some cm after removal the internal&externals? Let's say I want 5cm, how long should I lengthen to be sure? 6cm?

Answers from The Dictator:

1. Yes. Muscles in your upper and lower legs are connected by tendons, ligaments, fascia and other soft tissues. When you lengthen one part of your leg it stretches these tissues throughout your leg. Each stretches to a different degree. Your hamstring will stretch also, which is why it is important to do physical therapy and weight bearing while you lengthen.
2. X-Legs (Genu valgum) and O-Legs (Genu varum) naturally occur in the legs of some people and can be corrected during leg lengthening. It can also be caused by leg lengthening if it is done improperly.
3. Stretching in bed is not enough to keep yourself from getting ballerina foot (Equinus contracture) while lengthening tibias for most people. Weight bearing and direct pressure on the soft tissues is what keeps the body closest to its natural state of use and is the best way to prevent it. Pin bending is common for patients that lengthen with an Illizirov Frame if they weight bear on that frame while lengthening. How much depends on many factors. It is better to have pin bending and lengthen a little longer than to sit in bed for months on end and then have a long recovery from ballerina foot.
4. Eating properly will help you heal faster than taking supplements and not eating enough of the nutrients you need. Food contains vitamins that are eminently more absorbable than a multi-vitamin pill.
5. You are much better off preventing ballerina foot (Equinus contracture) and duck-ass (Hyperlordosis) in the first place. This can be done to a different degree in every patient with daily physical therapy, weight bearing, and safe physical activity that involves the legs (pilates, yoga, exercise bike). Rarely is surgery necessary to remove the condition if you get it. Weight bearing over time (by walking) will resolve the issue almost all of the time.
6. Most doctors have their patients cover the frames with some sort of plastic cover.
7. This varies with each patient. Do not expect your result to be exactly the same as another patient. Your doctor can give you a guideline for what is common, but this is very individual.
8. This tends to be very little. I have seen some people claim as much as .5 CM but I have not seen evidence of it.

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Questions from Member

1) what can you tell about the knee damage after LL? Ive heard many LL will suffer from knee pain in future.
2) is there a way to speedup your recovery time (beside eating, drinkin, exercising,...)?
3) im going to do tibias in summer with lon, all ill do is train my muscles (legs) and stretch a lot, are there any other suggestion to prepare myself?
4) do you recommend sringari? Because he's the only one in my price range Sad. (Gotta do in summrr 2014, now or never).
5) please correct me if wrong: ballerina is caused by lack of physio during LL, but it can be "cured" after ll right?

Answers from the Dictator

1. I have seen a lot of LL patients, and almost all of them have fully recovered. The only one I know of personally that had serious knee problems did external femur lengthening and had a lot of problems. I would avoid external femur lengthening if you can. I had pain in my knees after LL but it went away. If you lengthen a reasonable amount and are religious with your physical therapy then you should be fine.
2. No. The less you lengthen the faster you will recover, but there is no magic bullet to make your body heal faster if you are healthy and doing everything right. You sure as hell can slow it down by doing everything wrong.
3. No. Have strong legs, good health, good flexibility and prepare your self mentally for the pain and difficulty of LL and you will do fine.
4. I have met and spoken to Dr. Sringari and we talked extensively about patient care (I had just fought with Dr. Sarin about that same topic and it was fresh on my mind). I believe he is a good doctor and is doing a good job for his patients so far. I am keeping an eye on him as best as I can from half way around the world.  ( This part is BULL )  Permanent effects of LL
5. Ballerina is caused by your ligaments being stretched because the bone they are attached to is getting longer and they cannot adapt quickly enough. They are forced to stretch and adapt by the forced stretching of physical therapy and weight bearing.
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Posted on Dec 11, 2013, 2:42 pm
#16
Quote from: Tall on December 11, 2013, 03:42:14 AMThe patellar tendon is split in order to insert IM nails into the knees.

Unfortunately, there is no other way to insert a lengthening nail into the tibia.

Wrong! Well trained surgeons almost never split the patella tendon to insert an IM nail for tibia lengthening. That is why Dr. Sarin split the patella tendon because he is not well trained. Well trained surgeons go around the patella tendon. If you actually read what Dr. Birkholtz said then you would know that splitting the patella tendon or going around the tendon is not the cause of the life long knee pain. It's the change in the structure of the bone after reaming the tibia.

Quote from: Franz on December 03, 2013, 08:57:07 PMNobody really seems to know. Initially we thought it may have do do with whether you split the patella tendon to insert the nail. Going through or next to the tendon does not seem to make a difference though.
It probably is multifactorial, but may have something to do with the change in threedimensional architechture of the proximal tibia as a result of the nail. Put in layman's terms: it's probably because we make a huge hole and shove a piece of metal down it!
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Posted on Dec 11, 2013, 5:27 pm
#17
Quote from: Rivers on December 11, 2013, 02:42:02 PMWrong! Well trained surgeons almost never split the patella tendon to insert an IM nail for tibia lengthening. That is why Dr. Sarin split the patella tendon because he is not well trained. Well trained surgeons go around the patella tendon. If you actually read what Dr. Birkholtz said then you would know that splitting the patella tendon or going around the tendon is not the cause of the life long knee pain. It's the change in the structure of the bone after reaming the tibia.

Thanks for correcting this misunderstanding, Rivers. Still, the risk of permanent knee pain is directly caused by putting IM nails in the tibiae, so the only way to avoid that would be do use external fixation exclusively, correct?
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Posted on Dec 11, 2013, 5:52 pm
#18
But how about internal femurs? Is the chance on me ending up with a knee pain after doing internals on femurs as big as for doing internal tibias?
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Posted on Dec 11, 2013, 9:34 pm
#19
Hi everybody,

To ascertain the long-term effects of LL one has to look at different scenarios. The worst case is being crippled for life, amputations, chronical infections, chronical pains, premature arthritis, etc. The best case is being taller without any negative long-term effects. Everybody hopes for the latter, but what if something out the worst happens? There will be no plan B. And there won't be any going back to the state before LL. Therefore anybody considering LL should be really aware of those risks and really imagine what could happen. Are you really willing to gamble with your health?
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Posted on Dec 11, 2013, 10:19 pm
#20
Quote from: Rivers on December 11, 2013, 02:42:02 PMWrong! Well trained surgeons almost never split the patella tendon to insert an IM nail for tibia lengthening. That is why Dr. Sarin split the patella tendon because he is not well trained. Well trained surgeons go around the patella tendon. If you actually read what Dr. Birkholtz said then you would know that splitting the patella tendon or going around the tendon is not the cause of the life long knee pain. It's the change in the structure of the bone after reaming the tibia.

In the quote from Franz he says it doesn't make a difference whether it's split or pulled aside, you have the same result, so what does it matter?  Is this more anti-Sarin fiction from old forum  like that whole c-cut business?
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