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Tibias = 30% risk of permanent pain?

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Alcibiades
Verified Member
Posts: 459
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#1
Long femurs + athletic guy here.

Found this claim in a 10-year-old-thread and wondered if anyone knew anything about this or where this claim might come from:

"Seeing as you're interested in sports and are interested in tibial lengthening, I would highly advice against having a rod/nail inserted inside your tibia bone because it prevents it from healing properly and this leaves a 30% risk of developing permanent knee-pain." http://www.limblengtheningforum.com/index.php?topic=321.msg4971#msg4971

In Cyborg interviews I have not heard any references to an internal fixator in the tibias leading to a 30% risk of permanent knee pain.
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tallmen
Verified Member
Posts: 293
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#2
There's enough research on this topic now and yes, this is a risk of tibia nailing so that's why if you are going to do just 1 lengthening then do it on your femurs.

1.
https://journals.lww.com/jorthotrauma/abstract/1997/01000/knee_pain_after_tibial_nailing.4.aspx#:~:text=Knee%20pain%20is%20the%20most,multifactorial%20and%20requires%20further%20study.

2.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333649/
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Alcibiades
Verified Member
Posts: 409
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#3
Likely needs to be tibias for me - my femurs are long. Notable from 2016 study:

"Our study suggests that anterior nail prominence of more than 5mm and superior prominence of nail closer to tibial articular surface are associated with anterior knee pain. Hence we recommend extra-articular entry point, burying the nail tip and avoiding nail tip proximity to tibial plateau."

Definitely underscores the importance of having a good surgeon. Any testimonials / information out there on which surgeons are better at these techniques?
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tallmen
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Posts: 147
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#4
Likely needs to be tibias for me - my femurs are long. Notable from 2016 study:

"Our study suggests that anterior nail prominence of more than 5mm and superior prominence of nail closer to tibial articular surface are associated with anterior knee pain. Hence we recommend extra-articular entry point, burying the nail tip and avoiding nail tip proximity to tibial plateau."

Definitely underscores the importance of having a good surgeon. Any testimonials / information out there on which surgeons are better at these techniques?

I'd say go with the best surgeon you can if you are going for tibia. If you live in the US then maybe go to Paley or HSS.
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heightiseverything
Verified Member
Posts: 243
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#5
"A greater incidence of knee pain was found when nail was prominent more than 5mm and when it is in the proximal third distance from tibial plateau to tuberosity. Patients should be aware of high incidence of knee pain when the nail tip is placed in proximal third and prominence of more than 5mm."

"The causes of knee pain after tibial nailing are multi-factorial and require further study."

So it appears the instance of pain depends on the diameter and inserting position of the nail. These can be avoided with good surgeon. Also couldn't find anything written about permanent pain specifically after nailing and why it happens.

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bcnman
Verified Member
Posts: 402
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#6
Knee pain after tibial lengthening is a fact. If you think you won't develop it, you are delusional.
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GrowGrow123
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Posts: 139
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#7
How do you know you have long femurs? Did you get it measured by a doctor? What's your Tibia to Femur ratio?

I would verify this instead of just assuming or trying to eyeball it.
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B
Body Builder
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Posts: 386
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#8
Knee pain after tibial lengthening is a fact. If you think you won't develop it, you are delusional.
Thats for sure not true, at least if we talk about external tibias. It is the safest (with hexapods) and by far the less painful way to do LL.
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kja
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Posts: 200
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#9
Knee pain after tibial lengthening is a fact. If you think you won't develop it, you are delusional.

How do you possibly know?? - delusional?? - have you been to Russia you clown??

Ilizarov is the safest method - there is no pain whatsoever - pure BS.
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kja
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Posts: 374
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#10
I meant no pain after lengthening - there is pain during the process, but it is manageable really 👍
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ballerina
Verified Member
Posts: 49
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#11
I did LON 5cm (more than 15%, but below 17.5% of my original bone length) tibias and experienced no pain after the lengthening phase. Even the pain during lengthening was manageable. Should be ok with a good surgeon and reasonable lengthening amount.
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kja
Verified Member
Posts: 431
Joined: Jun 2026
Posted on Jun 18, 2026, 8:32 pm
#12
exactly - exrenal IIlizarov is performed on kids for God's sake - it is the safest method 👍
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