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[Libertin]

Hello!

I was reading many topics and medical reports for a few weeks and am still unsure, whether if I shall undergo one of these procedures or not.
My situation:
30 years, active soccer player (amateur level), active bodybuilder (even more so ); just enjoying sports very much
Right leg is 2cm (0.78 inches) shorter, 1,4cm for the tibia, some 0,4cm for the femur and a little bit from my foot)

Since I am suffering from a mild scoliosis (pelvic obliquity 2,4cm (0,94 inches); [2,4cm-2cm=0,4mm]) and due to the nature of soccer shoes I cannot correct the difference completely with insoles, I am eligible to get a leg lengthening operation for either Precice 2 (the 8mm version is necessary, as my bones are of a small diameter) or an external fixation.

As the Precice 2 offers a lot of comfort and less scars, my doctor is advising me to use that method, but after I found out, that, allegedly, 25% of all patients, who have undergone a lengthening through a nail in tibia, ended up with permanent knee pain, I am very doubtful. My doctor never heart of this study, as he never heart of permanent knee problems after lengthening tibia (he is an assistant doctor and not my surgeon, that is why he seems to have no clue what he is actually advising).

To come to the question:
Is it true, that I might end up with permanent knee pain if I use Precice 2 in my tibia? Are there other risks from this method which could influence my sports life?
The external fixation has the scars and the longer recovery phase on its downside but no long-term effects influencing my fitness level?
Since I don't consider this operation for cosmetical or psychological reasons, the only goal is to become more healthy, I would thankfully accept a longer recovery phase if it gives good odds to get back to 100% after several months or even a year.
Has the lengthening phase (eg. 0,5mm per day to 1mm per day) an effect on my fitness level I will be able to reach once my recovery phase ended?
The people in the old forum, old forum , are denying problems with internal nails and knee problems, maybe you enlighten me and I come to a conclusion?

Thank you very much!

[Franz]

Hello!

I was reading many topics and medical reports for a few weeks and am still unsure, whether if I shall undergo one of these procedures or not.
My situation:
30 years, active soccer player (amateur level), active bodybuilder (even more so ); just enjoying sports very much
Right leg is 2cm (0.78 inches) shorter, 1,4cm for the tibia, some 0,4cm for the femur and a little bit from my foot)

Since I am suffering from a mild scoliosis (pelvic obliquity 2,4cm (0,94 inches); [2,4cm-2cm=0,4mm]) and due to the nature of soccer shoes I cannot correct the difference completely with insoles, I am eligible to get a leg lengthening operation for either Precice 2 (the 8mm version is necessary, as my bones are of a small diameter) or an external fixation.

As the Precice 2 offers a lot of comfort and less scars, my doctor is advising me to use that method, but after I found out, that, allegedly, 25% of all patients, who have undergone a lengthening through a nail in tibia, ended up with permanent knee pain, I am very doubtful. My doctor never heart of this study, as he never heart of permanent knee problems after lengthening tibia (he is an assistant doctor and not my surgeon, that is why he seems to have no clue what he is actually advising).

To come to the question:
Is it true, that I might end up with permanent knee pain if I use Precice 2 in my tibia? Are there other risks from this method which could influence my sports life?
The external fixation has the scars and the longer recovery phase on its downside but no long-term effects influencing my fitness level?
Since I don't consider this operation for cosmetical or psychological reasons, the only goal is to become more healthy, I would thankfully accept a longer recovery phase if it gives good odds to get back to 100% after several months or even a year.
Has the lengthening phase (eg. 0,5mm per day to 1mm per day) an effect on my fitness level I will be able to reach once my recovery phase ended?
The people in the old forum, old forum , are denying problems with internal nails and knee problems, maybe you enlighten me and I come to a conclusion?

Thank you very much!

Hi,

With the info you have given I would support doing a tibial lengthening.
Although I do not see the amounts of anterior knee pain quoted in literature, I would think that it should not be ignored. For your situation I think an exfix only technique is the most appropriate as it will allow full weight bearing throughout.  Expected frame time is around 4 months.

[Libertin]

It is tibial lengthening only which was offered me, so no reason to discuss whether tibial or femoral lengthening shall be done.

Here are some studies of persisting/permanent knee pain after a nail has been inserted in tibia:
http://www.ncbi.nlm.nih.gov/pubmed/8990026

Of patients with knee pain, 80% (49/61) required nail removal. At a mean duration of 16 months following nail removal, pain was completely relieved in 22 patients and partially relieved in 17. In the remaining 10 patients, there was no improvement.

Also on this forum, it has been discussed widely:
http://www.limblengtheningforum.com/index.php?topic=179.0

There's a 50% Chance of persistent knee pain after the tibial nails are inserted.  Of those patients who have knee pain complication, only half (50%) had improvement (pain free?)  when the nails were removed.

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.

If this is the situation nowadays (?) with intramedullary nailing, then I will either choose external fixation or forego it completely and live with a shorter leg and the scoliosis.
External Fixation:
Is it possible to sleep on the side and especially on the belly while you wear it?
As I cannot find sleep if I have to lie on my back, this is a very important question.

[crimsontide]

i just want to be sure... it seems that  at he end, only 25%, not 50% experience knee pain forever, after removal of tibia nail?

libertin... im a patient with external fixation... i can tell  you for sure,  you will not,  or you will have much difficulty lying on your side or belly with frames, especially in the beginning... it has definitely hurt my ability to sleep, and one of the main reasons i want to remove frames... but i've somehow managed to survive  a few months this way, so you could too... it will not be fun or easy, but you can do it

[Medium Drink Of Water]

External Fixation:
Is it possible to sleep on the side and especially on the belly while you wear it?
As I cannot find sleep if I have to lie on my back, this is a very important question.

I managed to sleep on my side with my legs fanned out (not stacked) on many nights, and that was with two Ilizarov frames on. I think you'll manage okay with just one.  Sleeping on my stomach just wasn't possible because of the bulkiness of the frames though.

The doctors kept telling me to sleep on my back with my knees locked, but it was impossible to sleep like that.  I always had them bent whether I was on my back or my side.  I didn't suffer permanent complications because of it, just maybe a slower recovery, which was likely more than made up for by the amount of sleep I got compared to other LLers.

[Libertin]

Thank you for your answer.
It's all very bad news.
Having either an extremely high risk of permanent knee damage (if so for real) or not being able to sleep for 4 months, it seems like there is no solution for me.
I remember once having a Sinusitis and the only lying position where I had no pain in my head was on the back. I remember perfectly how I was not able to find one second of sleep for two long days, lying hours in my bed and waiting for the doctor to open his medical office. 
Actually I don't remind any night where I fell asleep lying on my side. When I sleep on my belly, one leg is, naturally, stretched out with the tibia in full contact with the mattress. As Ilizarov frames are very bulky on the side of tibia, I fully understand why you could not find any sleep on your stomach and it makes it very clear, that unless I find a clever solution, I won't be able to use this frames for me.

Knee pain:
Could it be that the pain results from the screws, which are for example inserted wrong (eg too near the patella)?
Precice 2 also has these screws, so it makes no difference if an intramedullary nail is used for leg lengthening or to heal a broken bone, as all of these studies are referring about?
http://www.ncbi.nlm.nih.gov/pubmed/8990026
http://www.healio.com/orthopedics/journals/ortho/%7B1f675433-0c46-41ae-9bd6-a5c722b26415%7D/influence-of-nail-prominence-and-insertion-point-on-anterior-knee-pain-after-tibial-intramedullary-nailing
http://www.ncbi.nlm.nih.gov/pubmed/11940618
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247032/
https://bib.irb.hr/datoteka/536771.Darabos_Coll_Antr.pdf

On the basis of our results from two different groups
regarding AKP, we confirmed an association between
AKP and nail position. We presume that the position of
the proximal tip of the nail and its negative influence on
the innervation pattern of the area dorsal to the patellar
tendon could be the key factor of AKP

[crimsontide]

libertin....     your body will sleep,  it has to... it just will be difficult at first.... but you can do it

knee pain, i don't have nails in my knees, but i think the knee issues are a concern, but not a deal breaker... medium seems to be doing ok...


the  lack of sleep in the beginning will drive you crazy, but it will pass.... the first few nights after the surgery, all i thought was, how the hell am i gonna do this, i can't even do this 1 more day, i can't sleep.... but your body will gt used to it, because it has no choice... it's still not perfect, since i have frames on, but manageable.... it is definitely rough, but you if you are mentally strong, you can do it

[Medium Drink Of Water]

I agree with crimsontide, you'll manage to sleep.  I've seen it happen.  We had a few stomach-sleepers at the hospital who said it was tough for them in the beginning but that they got used to it, not having any other choice about how to sleep.

[Libertin]

How are the chances for success to regain 100% of health once the leg lengthening procedure with an external fixation?
My current knowledge is that infections occur definitely and aswell as large scars will remain.
Are ankle problems known as a risk of this procedure?
Do you say a lengthening of one leg by 2cm will reduce the legs explosivity, durance and strength?
I've red from others here that almost everyone notices a reduction in sportivity after their lengthening procedure has been finished, although they lengthened 4-10cm mostly.

[Medium Drink Of Water]

I think you have a good chance of regaining 100% of your leg health and strength/endurance, since you're only doing 2cm.

Infections may or may not occur.  I managed not to get any infections the whole 5 months I was in Beijing.

I don't have any ankle problems as a result of the surgery.  As long as it's done right, I don't think there's much risk of that.

I think you'll be fine lengthening only 2cm.  You're good to go in my unprofessional opinion.