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[ReadRothbard]

So, I've fallen for the conventional wisdom that 6-7 cm on the tibias and about 8 cm on the femurs are the "safe" limits. That sounded about right; muscles only have so much elasticity. But, then I found this after a little bit of research:

http://limblengtheningdoc.org/methodsandstrategiesinlimblengtheningrealignmentforskeletaldysplasia.pdf

On the second page of the PDF, it says this, and I quote:

"In the femur, the safe magnitude of lengthening is 8-12 cm in one treatment. For the tibia and the femur, the safe limits are 10-16 cm. These limits are mandated primarily by the soft tissues and the joints."

That is far, far more than the forum members traditionally advocate. Also, while the document primarily addresses those with Skeletal Dysplasia, those safe magnitudes seem to be general for the entire population.

What do you think?

[KiloKAHN]

For healthy adults that don't have anything like dwarfism or limbs that were shortened in an accident, I think 10-16 cm is far too much. I don't have any studies in front of me, but I started having problems arise after the 5 cm mark, and Dr. Parihar told me that in his over 20 years of experience people definitely have issues with tibial lengthening by 6 cm. Going 10 cm - 16 cm would require much more watch on the part of the surgeon and most likely a lot of corrections along the way. Not to mention you'd require years for functional recovery (running and jumping). I can only see 10 - 16 cm being more manageable for those with achondroplasia or a limb that's much shorter than the other.

[TRS]

Those safe limits would apply to people suffering from skeletal dysplasia. I have been told by several surgeons that people who suffer from dysplasia have shortened bones but elongated, normal muscles and soft tissues. Therefore they're able to lengthen such large amounts.
For normal CLL patients, Dr.Paley does specify the safe limits http://www.paleyinstitute.org/?q=node/47.

Have you read page 195 of the PDF? There are interesting statements about constitutional short stature and limb lengthening.
-"Since these patients are otherwise normal in every way, stature lengthening can only lead to functional worsening"
-"Since functionally these patients are normal, they may be made functionally worse by limb lengthening"

Maybe we're wrong about the safe limits since any amount of lengthening can potentially worsen limb function.
 

[Polycrates.]

The article clearly states that it pertains to skeletal dysplasia patients. I haven’t read its contents,  but unless it explicitly states otherwise, I would say these limits are relevant only to those patients, not normal adults. I've done 6cm as well, and am still not close to normal flexibility. I can't imagine doubling that length - both in terms of what it'd look like and how it would function.

[123]

Why stop at 16cm tibia? Go for 30cm. LL doctors only do 6cm because they are dumb.

Do 30cm tibia and then 30cm femurs.

[ReadRothbard]

Those safe limits would apply to people suffering from skeletal dysplasia. I have been told by several surgeons that people who suffer from dysplasia have shortened bones but elongated, normal muscles and soft tissues. Therefore they're able to lengthen such large amounts.
For normal CLL patients, Dr.Paley does specify the safe limits http://www.paleyinstitute.org/?q=node/47.

Have you read page 195 of the PDF? There are interesting statements about constitutional short stature and limb lengthening.
-"Since these patients are otherwise normal in every way, stature lengthening can only lead to functional worsening"
-"Since functionally these patients are normal, they may be made functionally worse by limb lengthening"

Maybe we're wrong about the safe limits since any amount of lengthening can potentially worsen limb function.

But those limits are not referring to those with skeletal Dysplasia. While the PDF is generally about about those with the disorder, it states that these recommendations are for all Caucasian males and females under 160 cm (5'3) and 150 cm (4'11), respectively--including those without Dysplasia.

Since the PDF is only 18 pages, I don't know what you are referring to when you say page 195.

Edit: Are you referring to the PDF on Dr. Paley's site? That one also is only about 18-20 pages long.

[ReadRothbard]

Why stop at 16cm tibia? Go for 30cm. LL doctors only do 6cm because they are dumb.

Do 30cm tibia and then 30cm femurs.

Plenty of fantastic ll doctors do far more the 6 cm on the tibias. Please take your ignorance elsewhere.

Edit: Here are a few:
Dr. Paley
Dr. Guichet
Dr. Betz (though his ethics are debatable)
Dr. Xia & Dr. Li
Dr. Rainer Baumgart
Dr. Leonid N. Solomin
Dr. Mehmet Kocaoglu
and the Russian Ilizarov Scientific Centre at Kurgan

[TRS]

But those limits are not referring to those with skeletal Dysplasia. While the PDF is generally about about those with the disorder, it states that these recommendations are for all Caucasian males and females under 160 cm (5'3) and 150 cm (4'11), respectively--including those without Dysplasia.

The doctors mention that the goal of the treatment is to bring the individuals suffering from dysplasia up to the lower limit of normal accepted height which is 160cm for males and 150cm for females. Therefore I believe they are referring to only those suffering from dysplasia.

Since the PDF is only 18 pages, I don't know what you are referring to when you say page 195.
Edit: Are you referring to the PDF on Dr. Paley's site? That one also is only about 18-20 pages long.

Page 195 is written on top of the page. I'm referring to the PDF

[programdude]

Even if that were true for cosmetic patients, going beyond 8 seems outrageous for proportions and functionality. I think if the rod allowed I could have easily done 10 but christ I'd look foolish. This would be even more true for patients with shorter starting heights.

[ReadRothbard]

The doctors mention that the goal of the treatment is to bring the individuals suffering from dysplasia up to the lower limit of normal accepted height which is 160cm for males and 150cm for females. Therefore I believe they are referring to only those suffering from dysplasia.
Page 195 is written on top of the page. I'm referring to the PDF

Ok, I get what you are saying about the page numbers. However, the document does also say that anyone below that lower limit of height is a worthy candidate, meaning that those safe magnitudes still apply. I will look for information to otherwise clarify these suggested safe ranges.

[TRS]

Keep in mind that this was written in 1995 and would've have been a learning curve for both Paley and Herzenberg. There must be a reason to why Dr.Paley has dropped his safe limits for normal CLL patients.

[ReadRothbard]

This is true, but he might just be acting conservatively. Btw, in your opinion, did 7 cm on your tibias cause any problems? I would eventually like to get 7 cm on my tibias and then 8 cm on my femurs.

[KiloKAHN]

Come to think of it, Herzenberg would also be a great choice for CLL given his years of experience. I wonder if he also accepts cosmetic patients.

[theuprising]

I don't see the big deal with this is. When it states that 8-12cm for femur and 10-16cm for tibia and femur wouldn't that still mean a maximum of 8cm on tibia? The way it reads is that if you only do femur you can do 8-12cm but the maximum lengthening for doing tibs and femur combined is 16cm. At no point does it read that the Doctors are advocating 10-16cm on tibia alone.

[TRS]

Come to think of it, Herzenberg would also be a great choice for CLL given his years of experience. I wonder if he also accepts cosmetic patients.

I did mention him to Dameon several months ago. He is equally experienced and good as Paley. I believe that he also helped create the PRECICE nail and the LON method along with Paley. But unfortunately he is unknown in the CLL community. It will be worth emailing him.

[TRS]

This is true, but he might just be acting conservatively. Btw, in your opinion, did 7 cm on your tibias cause any problems? I would eventually like to get 7 cm on my tibias and then 8 cm on my femurs.

I did around 7.5cm on my femurs. It did not cause any problems so far since it corrected my pre-existing femoral malalignment and I had no contractures or nerve pain. Athletic ability does not matter to me since I live a sedentary lifestyle.
 

[KiloKAHN]

I did mention him to Dameon several months ago. He is equally experienced and good as Paley and I believe that he also helped create the PRECICE nails. But unfortunately he is unknown in the CLL community. It will be worth emailing him.

I know Dr Parihar has worked with him as well and he mentioned that Dr Herzenberg isn't the type to advertise himself. Given how often he shows up in limb lengthening articles I think he'd be a great addition to the directory if he accepts cosmetic patients. I may just give him a call.

[123]

Plenty of fantastic ll doctors do far more the 6 cm on the tibias. Please take your ignorance elsewhere.

Edit: Here are a few:
Dr. Paley
Dr. Guichet
Dr. Betz (though his ethics are debatable)
Dr. Xia & Dr. Li
Dr. Rainer Baumgart
Dr. Leonid N. Solomin
Dr. Mehmet Kocaoglu
and the Russian Ilizarov Scientific Centre at Kurgan

That's why I said you should go for 30cm.

[TRS]

I know Dr Parihar has worked with him as well and he mentioned that Dr Herzenberg isn't the type to advertise himself. Given how often he shows up in limb lengthening articles I think he'd be a great addition to the directory if he accepts cosmetic patients. I may just give him a call.

I also think Dr.Dean Cole would be a good addition to the doctors list. He may be the best ISKD surgeon since he himself invented the ISKD nail.

[ReadRothbard]

Ok, athletic ability is important to me, but only so far as lower body muscular strength. I do strongman and powerlifting training, and sprinting + endurance running play next to no role in those sports. The consensus I've heard is that ll seems to have almost no effect on strength athletics (besides, perhaps, olympic lifting, which I have no interest in).

[KiloKAHN]

I also think Dr.Dean Cole would be a good addition to the doctors list. He may be the best ISKD surgeon since he himself invented the ISKD nail.

Yeah I e-mailed his clinic a few times and unfortunately got no response. Might have to try calling him directly.

[Polycrates.]

Kilo,

Herzenberg does indeed do CLL. There were a few on old forum , and even one here a while back, I believe. The issue with him is that the hospital in which he operates has astronomical costs, making him more expensive than even Paley. I might be seeing him in a few months time for an evaluation since I'm having difficulties getting to see someone again.

[KiloKAHN]

Kilo,

Herzenberg does indeed do CLL. There were a few on old forum , and even one here a while back, I believe. The issue with him is that the hospital in which he operates has astronomical costs, making him more expensive than even Paley. I might be seeing him in a few months time for an evaluation since I'm having difficulties getting to see someone again.

Thanks for the info. Guess it's another Rozbruch scenario. Great doctor, but more expensive than most can afford.

[Polycrates.]

Woops, thought it was Rozbruch being discussed. That's who I was referring to, not Herzenberg. My bad.

[GeTs]

In paley and herzenberg's biography it says that they trained with ilizarov and Maurizio Catagni, which makes me think why is Maurizio catagni on the same level as ilizarov, he's more experience than paley and others but because he isn't as well advertised people don't go to him, he's also cheaper than paley..

[Impromptu]

LOL you are not a doctor. Just find a doctor and listen to their advice.

If you bring these "studies" to doctors to try to convince them they're not going to treat you seriously.They're doctors for a reason. You don't know best, they do.

If (at this point,pre-LL) you still want to convince yourself that you'll be able to get >10cm on one limb then so be it. Whatever floats your boat. People believe what they want to believe.

[ReadRothbard]

I'm not trying to convince a doctor of anything. There are doctors that go above 10 cm per segment; I'm simply wondering if that is safe as far as function is concerned.

[Impromptu]

I'm not trying to convince a doctor of anything. There are doctors that go above 10 cm per segment; I'm simply wondering if that is safe as far as function is concerned.

Are we seriously having a discussion of whether >10cm on tibias is safe or not. It is not. Do you think doctors and patients who stick to under 8 (or even under 6) are stupid?

Better to be safe than sorry anyway.