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[TIBIKE200]

an experiment done in 2001 showing what happens to the muscles during lengthening in dogs

http://www.ncbi.nlm.nih.gov/pubmed/11302316

[TIBIKE200]

here is another one in rabbits

http://www.boneandjoint.org.uk/content/jbjsbr/77-B/4/630.full.pdf

[Genetic_solutions]

Reading these research papers reminds me of studying for finals back in college.

[Thatdude950]

From the study on rabbits:

"All the lengthened muscles except those distracted at 0.4 and 0.7 mm per day showed *significant* abnormalities, with a strong correlation between rate of distraction and histological appearance. In a cross-section of the muscle, the percentage of completely damaged fibres rose in an exponential manner with an increasing rate of distraction. With as little as 3.7% of fibres damaged there were additional morphological changes indicating disorganisation. The main abnormalities compared with the normal muscle were whored fibres and centralisation of nuclei; these indicate abnormalities of the contractile elements of the muscle. Abnormalities of the connective tissue of the muscle included excess thickening of the endomysium and perimy sium at rates of I mm per day and above. At the more rapid rates of distraction (such as 2.7 mm per day). There were gross changes with necrosis and disorganisation of the muscle structure"

[TIBIKE200]

these studies clearly show that 1mm per day distraction is harmful for the muscles (I believe the same applies for femoral lengthening and might also explain why there isnt a single decent case of recovery for femural lengthening).

 0.75mm which is the common distration rate for tibia today seems to be the upper border for safety (although not 100% safe at all). I believe that the original 0.66mm per day was indeed the best way to ensure muscles are free of massive damage and also reducing the risk of pre-consolidation.

[Thatdude950]

Healthy muscle, top left, vs lengthened muscle.

[hyong]

an experiment done in 2001 showing what happens to the muscles during lengthening in dogs

http://www.ncbi.nlm.nih.gov/pubmed/11302316

Thanks for the post, it is really informative 

[TIBIKE200]

From the study on rabbits:

The study also said that this damage did not accure with the 0.4 and 0.7mm distractions.

[Thatdude950]

The study also said that this damage did not accure with the 0.4 and 0.7mm distractions.

Not true. Look at the table. A distraction rate of of 0.4mm damaged 0.5% of muscle fibres, & 0.7mm damaged 1% of them. *Significant* damage begins at 3.7% of ruined muscle fibres, which occurred at 1mm+. But they made it clear that were still some problems even at a 0.7mm

Even at rates of 0.7 mm per day there was some loss of movement (mean 72%) at the ankle due to stiffness of the muscles.

[TIBIKE200]

Not true. Look at the table. A distraction rate of of 0.4mm damaged 0.5% of muscle fibres, & 0.7mm damaged 1% of them. *Significant* damage begins at 3.7% damage, which was 1mm+. But they made it clear that were still problems at a 0.7mm

This loss of movement (or muscle stifness) is solved with ATL

[Thatdude950]

This loss of movement (or muscle stifness) is solved with ATL

Good luck with that. You're a smart active guy Tbike, I hope you see that this is an insane gamble with your health.

[TIBIKE200]

Good luck with that. You're a smart active guy Tbike, I hope you see that this is an insane gamble with your health.

This is why it's better to stay at 0.75 or below. There is no fybrosis (which is permanent) or chronic inflamation. Yes it is a gumble but one sadly I am willing to take..

 What about you? Will you do LL or are you already doing it?

 

[Thatdude950]

There's not *none* of those problems at a slower rate, just less of a chance. Isn't it crazy that heaps of patients are still doing 1mm though? No wonder nobody comes out of this surgery well.

No and no to your questions.

[TIBIKE200]

There's not *none* of those problems at a slower rate, just less of a chance. Isn't it crazy that heaps of patients are still doing 1mm though? No wonder nobody comes out of this surgery well.

No and no to your questions.

Yep it's crazy. I believe it's crazy that people go to india to do it. I belive that it's crazy that people decide that a certain french doctor is the best based on an internet site and two forum.

 I decided to which doctor to go to not based on diaries or the internet but after talking to a bunch of top class orthopedic surgeons in my country and my currect host country (Italy).
 In the end after meeting the doc, he didn't promised me roses and candies. He said that it will be hard (especially psicologically). He said always "from my experience" which is something I value. He didnt say that I should do it nor did he say not do it (And there is nothing more hipocryte than telling you not to do it while handing over his hand in order to take your money).
 Honesty and directness (as well as clinical experience) are the things I value the most when choosing a specialist. I prefer my doc to be a total dck but good.
 I am well aware that it's a trade-off... One that I am sadly willing to take. My reasons are many (a few of them are written on a post i have put up in the "off-topic" section under "just wanted to share my thoughts" if you are interested).

[TRS]

This is why it's better to stay at 0.75 or below.

Keep in mind that higher distraction rate is necessary for patients that risk premature consolidation, even possibly around 1.5mm per day. Patients with premature consolidation will require another osteotomy in order to lengthen again. There is also a risk of damaging the internal lengthening nails with premature consolidation and the patient could end up paying the entire cost for a replacement nail and surgery.

[TIBIKE200]

Keep in mind that higher distraction rate is necessary for patients that risk premature consolidation, even possibly around 1.5mm per day. Patients with premature consolidation will require another osteotomy in order to lengthen again. There is also a risk of damaging the internal lengthening nails with premature consolidation and the patient could end up paying the entire cost for a replacement nail and surgery.

Yeah of course. But it is mainly in the femurs and the humerus. Both have a faster consolidation rate than tibias because of having greater vacularization. BUT the perfect rate for osteogenesis is not the same for miogenesis it seems. This is why (in my opinion) femoral lengthening should be avoided and instead go for the good old tibial lengthening.

[chineseguy]

how can you say no one recover from femur lengthening?  it seem there are some recovered like andrewschizel

[TIBIKE200]

how can you say no one recover from femur lengthening?  it seem there are some recovered like andrewschizel

With everything that happened with betz and apo, I consider the diaries of betz somewhat false...

[paddy10tellys]

May I enquire why you frequent this forum?

[TIBIKE200]

May I enquire why you frequent this forum?

me? Because I intend to do LL

[chineseguy]

thatdude, may i know why you here if you will not do this?

[paddy10tellys]

Sorry TBike, I was addressing the Q: to "thatDude950"

[Thatdude950]

see my post history re: my own BDD

[Nightwish]

these studies clearly show that 1mm per day distraction is harmful for the muscles (I believe the same applies for femoral lengthening and might also explain why there isnt a single decent case of recovery for femural lengthening).

 0.75mm which is the common distration rate for tibia today seems to be the upper border for safety (although not 100% safe at all). I believe that the original 0.66mm per day was indeed the best way to ensure muscles are free of massive damage and also reducing the risk of pre-consolidation.

But, does that translate to humans given the size differences as to the leg of a rabbit? Genuine question, I have no idea.

[TIBIKE200]

But, does that translate to humans given the size differences as to the leg of a rabbit? Genuine question, I have no idea.

it's a risk I prefer not to take on myself

[goldenegg]

But, does that translate to humans given the size differences as to the leg of a rabbit? Genuine question, I have no idea.

Yeah tough to tell since humans are so much bigger than rabbits.  you can't definitively make that conclusion as the research pointed out.  "It is not possible to compare absolute values between patients and experimental models."  If you were to compare absolutes, then it would be a bad idea to lengthen more than 2cm (the amount of lengthening on the rabbits). 

Their main conclusion does support the idea that slower distraction is better (as long as you don't risk pre consolidation like TRS said).

[JConnor]

Yeah tough to tell since humans are so much bigger than rabbits.  you can't definitively make that conclusion as the research pointed out.  "It is not possible to compare absolute values between patients and experimental models."  If you were to compare absolutes, then it would be a bad idea to lengthen more than 2cm (the amount of lengthening on the rabbits). 

Their main conclusion does support the idea that slower distraction is better (as long as you don't risk pre consolidation like TRS said).

Agreed, and I actually find the rabbit study very encouraging after making a rough comparison between rabbit and human lengthening.

For the sake of the argument, assume that human and rabbit muscle cells are the same size and have the same tolerance for stretching. Also, the human tibia is roughly 4 times the length of the rabbit tibia lengthened in the study.

The study says the rabbit muscles on the lengthened limb weren't damaged when lengthened at 0.4 mm per day.  Given the assumptions above, you could lengthen 1.6 mm (since the human tibia is 4 x longer) safely.

Think of it this way, if the rabbit muscle is composed of 10 cells, then lengthening 0.4 mm per day would stretch each individual cell 0.04 mm.  If stretching each cell that much is safe, then a human muscle containing four times as many cells (40) could be lengthened 1.6 mm per day, which would stretch each cell the same 0.04 mm as the rabbit.

Obviously, it's not that simple since the assumptions made don't perfectly reflect reality, but it's a good indication that lengthening 1 mm per day or less in humans is safe.  The rabbit study also examined the muscles right after lengthening, which does not consider the body's ability to repair the damage over time.

The main takeaway is that the less you stress your muscles during lengthening, the less they will be damaged. To accomplish that:
1. Stretch and improve flexibility as much as possible before surgery (you're basically pre-lengthening your muscles to give them a head start)
2. Distract lower total daily amounts
3. Distract in multiple small increments per day instead of all at once

[TIBIKE200]

Agreed, and I actually find the rabbit study very encouraging after making a rough comparison between rabbit and human lengthening.

For the sake of the argument, assume that human and rabbit muscle cells are the same size and have the same tolerance for stretching. Also, the human tibia is roughly 4 times the length of the rabbit tibia lengthened in the study.

The study says the rabbit muscles on the lengthened limb weren't damaged when lengthened at 0.4 mm per day.  Given the assumptions above, you could lengthen 1.6 mm (since the human tibia is 4 x longer) safely.

Think of it this way, if the rabbit muscle is composed of 10 cells, then lengthening 0.4 mm per day would stretch each individual cell 0.04 mm.  If stretching each cell that much is safe, then a human muscle containing four times as many cells (40) could be lengthened 1.6 mm per day, which would stretch each cell the same 0.04 mm as the rabbit.

Obviously, it's not that simple since the assumptions made don't perfectly reflect reality, but it's a good indication that lengthening 1 mm per day or less in humans is safe.  The rabbit study also examined the muscles right after lengthening, which does not consider the body's ability to repair the damage over time.

The main takeaway is that the less you stress your muscles during lengthening, the less they will be damaged. To accomplish that:
1. Stretch and improve flexibility as much as possible before surgery (you're basically pre-lengthening your muscles to give them a head start)
2. Distract lower total daily amounts
3. Distract in multiple small increments per day instead of all at once

There is one big flaw with your logic though... Human cells arent bigger than rabbit cells... Just like elefant cells arent bigger than human cells.. Thus the damage to a single cell would be the same. It also depends on the sarcomer length (the "muscle functional unit").
 The only difference between humans, rabbits and elefants is the numebr of cells but not the size

[TIBIKE200]

Another one on goats

http://www.ncbi.nlm.nih.gov/pubmed/12218494

Here is research was done with daily 0.75mm distraction. What's fascinating is that the results showed that the muscle is adapting not by stretching the already existing sarcomeres but by actually adding adittional sarcomers... I can only describe this as another proof of how our body is a marvalous machine

[TIBIKE200]

And here is one on HUMANS. 3 acondroplastics so not normal cases..

 To be noted that the distraction was of 1mm a day (4 times a day of 0.25mm every 6 hours) for a total elongation of 10cm.

Result show alot of muscle damage and poor adaptation (as opposed to what was seen in the goats)

http://www.bio.unipd.it/bam/PDF/5-2/Scelsi.pdf

[JConnor]

There is one big flaw with your logic though... Human cells arent bigger than rabbit cells... Just like elefant cells arent bigger than human cells.. Thus the damage to a single cell would be the same. It also depends on the sarcomer length (the "muscle functional unit").
 The only difference between humans, rabbits and elefants is the numebr of cells but not the size

What? This is what I said: "assume that human and rabbit muscle cells are the same size"

If they are the same size, and then a human tibia, which is 4 times longer than a rabbit tibia, should have about 4 times more muscle cells length-wise. Since the stretching is divided among 4 times more cells, each cell stretches less and is at less risk for damage.