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[TRS]

Hey guys,

Just wondering if LATN/LON is really worth lengthening with?

Especially if the risk of permanent knee pain is 30-50%.

From what I have read on this forum, people risk permanent knee pain regardless of how much they have lengthened.

Isn't it a better option to rather do pure external fixation and having the fixator on for several more months and not risking permanent knee pain?

Guys who have lengthened via LON/LATN, please share whether your having knee pain and whether the pain is sharp or subtle?

[KiloKAHN]

A lot fewer people would have done LON/LATN if they knew about the risk of permanent knee pain. Although I vaguely remember a study that was posted by someone (Stadiometer?) on the old forum which said permanent muscle damage happens when you wear a fixator for longer than a certain period of time. I forgot how long the duration was according to the study, IIRC it was 3 or 4 months.

Curse this foggy memory of mine.

Edit: I just remembered Dr Birkholtz posted that long frame times don't necessarily equate to permanent muscle damage, so this makes it a little more hard to say concretely.

[TRS]

Hey Kilokahn,

Thanks for the reply.

Sorry but what I am asking is the risk of permanent knee pain from the insertion of the internal rod into the tibia and not the duration of the external fixator.

Wouldn't it be better if a person wears the fixator for several more months then inserting a rod merely for the comfort and risk permanent knee damage?

[KiloKAHN]

Hey Kilokahn,

Thanks for the reply.

Sorry but what I am asking is the risk of permanent knee pain from the insertion of the internal rod into the tibia and not the duration of the external fixator.

Wouldn't it be better if a person wears the fixator for several more months then inserting a rod merely for the comfort and risk permanent knee damage?

I meant to say that there is the possibility you'd have to decide which bothers you more, risk of permanent knee pain with LON/LATN or risk of permanent muscle damage with external only for the same amount of lengthening, which is of course if ex only does truly lead to permanent muscle damage. If you can get permanent muscle damage from ex only, maybe the knee pain without the muscle damage is a better deal?

[theuprising]

Would precise 2 in tibia also have a possibility of leading to permanent knee pain?

[mediocre]

Personally, nothing is worth if I have permanent pain anywhere.
To each his own I suppose.

[KiloKAHN]

Would precise 2 in tibia also have a possibility of leading to permanent knee pain?

Seems like anything internal would make permanent knee pain a possibility since they'd have to split the patellar tendon to put it inside.

[Smallguy]

Yes, it really worth it.

Unfortunately, I only have myself to make this claim and so far I don't have any pain or issue... except for some annoyances which I have mentioned in my diary.

If anyone want to see, I could again... make a video of a death-lift or whatever lift that is at the gym... haha, I don't want to sound like a dckk and be hated but it's true. I don't know where all the pain are coming from.

[Smallguy]

actually, I do feel a loss of sensation on my right leg when I cross my leg over for too long.

[Medium Drink Of Water]

I've been thinking recently about LON.  One of the advantages of LON/LATN is that they can correct the angle of your feet in the 2nd surgery when the fixators are removed and the nails are locked.  This isn't possible with all-internal or all-external methods.

I was duck-footed (A) going into the surgery, and throughout the lengthening process my feet moved inward, slightly correcting the duck-footedness.  This inward movement happened to almost everyone at the clinic: their feet twisted inward, turning them pidgeon-toed (B) if they started with a normal foot angle.  Everyone got a 100% correction during the 2nd surgery though, leaving our feet anatomically perfect.

[Muse]

Here's a general overview of the LON/LATN/LAP  techniques.  It's titled "Hybrid Techniques: The Best of  Internal and External Fixation"  presented by Dr Robert Rozbruch

http://www.hss.edu/files/LL-Hybrid-Techs-McGill.pdf

[mediocre]

Thanks for this.

Seeing the slide with 10cm distraction...
10 cm is just huge!

Here's a general overview of the LON/LATN/LAP  techniques.  It's titled "Hybrid Techniques: The Best of  Internal and External Fixation"  presented by Dr Robert Rozbruch

http://www.hss.edu/files/LL-Hybrid-Techs-McGill.pdf

[kneehowguys]

MediumDrink,

1. What will give you the best chance of no knee pain?

2. What does running feel like?

3. Could you post more pictures of your scars up close in good lighting?

4. Why a burn specialist for LL scars? You don't have burns. How did you decide on what type of scar revision surgery to do? Why not geometric broken line revision?

5. If you had to get externals/LON tibias now, where would you go? Including cost in the equation. Part of me wonders if Beijing + scar revision surgery costs almost as much as Jamal.

[Medium Drink Of Water]

MediumDrink,

1. What will give you the best chance of no knee pain?

2. What does running feel like?

3. Could you post more pictures of your scars up close in good lighting?

4. Why a burn specialist for LL scars? You don't have burns. How did you decide on what type of scar revision surgery to do? Why not geometric broken line revision?

5. If you had to get externals/LON tibias now, where would you go? Including cost in the equation. Part of me wonders if Beijing + scar revision surgery costs almost as much as Jamal.

1. Probably internal femurs with the nail inserted through the hip.  Nobody's really sure what it is about tibiae IM nails that causes knee pain.  ChrisIsaak here says he has no pain with the nails going into the femur through the knee though.

2. Running felt weird the first time I did it, like I was on stilts.  Now it just feels normal, although my legs are more prone to getting tired if I have to do distance running.

3. It's hard to get the pictures to come out well.  This one is the best I can do after taking a bunch just now.  It shows two scars from the pins near the left knee that have been excised.

4. I went to a regular plastic surgeon for all but the osteotomy scars, which the plastic surgeon said he wouldn't touch due to the thinness and superficiality of the skin directly covering the tibiae.  It took me a while to find a doctor who'd have enough confidence in his abilities to take on my two osteotomy scars, and he happened to be a burn specialist who's an expert at scar revision anywhere on the body, since people can't be choosy about where they get burned.  All of my scar treatments were simple excisions, and I'm sure the doctors knew what broken line revision is but just decided not to use it.

5. Beijing and scar revision probably does cost as much as Jamal, especially with the disproportionate price increases since 2007.  There was no way at the time for me to afford Dr. Dragan (Jamal's mentor who did the surgery at the time).  It was $10k more that I didn't have and couldn't get in a reasonable amount of time.  It was over a year before I started to get the scar revisions done.

My first choice was to get external-only tibiae LL with Dr. Mitkovic because I didn't like the invasiveness of internal nails, lengthening or fixed.  So if I had it to do over again, I'd go back to Serbia and not mention the mental health medications.  His devices are small enough that it's not too bad to wear them for 9 months, not like Ilizarov frames which would have you hating life for sure if you wore them for that long.

[programdude]

About how much did scar removal cost?? Your scars look great!

[Medium Drink Of Water]

$5000 for 16 scars from the 8 pins that were in my legs, but I got it done by a Beverly Hills plastic surgeon.  You could probably get it done a bit cheaper elsewhere.  Beverly Hills is close to me and has the best surgeons, so I just went there.

The osteotomy scars have been much more troublesome.  That plastic surgeon didn't want to touch them and I should've listened to him and left them alone.  I went to a burn specialist to get them taken care of, and needed 4 excisions on the left leg and 2 on the right (the left scar was quite a bit worse) before they finally turned into white lines.  Those excisions were $400 each.  Each time, there was a risk of messing up the skin worse than it was before, and that's a gamble I won but wouldn't take again.

[programdude]

Gotcha. How bad are the scars initially though? If a tan and some hair obscures them I wouldnt care. If it looks like cancerous blotches thats more of a problem.

[Medium Drink Of Water]

The severity of the scars varies a lot from person to person, even among fellow Beijing patients who lengthened the same amount I did.

[programdude]

Gotcha. And how bad were yours before?

Also LON seems like what I want to do, other than this constant knee pain that would come of it. That is the single most thing that concerns me. How would you describe the pain? Is it a kind of pain that would keep you up at night, that you would notice during any given outing? For me if it is an occasional twinge of pain, or a dull ache here and there it isnt a big deal. But if every activity in life is underscored by suffering like that and quality of life is ruined, then its not.

[Ronaldo]

MODW mentioned the knee pain here 
http://www.limblengtheningforum.com/index.php?topic=288.0

[kneehowguys]

Hey Medium Drink,

So if you were to do scar revision over again, would you just go directly to a burn specialist and do whatever he says?

I'm wondering for people who do internal femurs if it is just better to leave the nail in there for the rest of their life.

[kneehowguys]

"I'd go back to Serbia and not mention the mental health medications"

I've never taken mental health medications but I am thinking of seeing a doctor to ask about adderall and ADHD.

So you can just go to a foreign doctor and tell them whatever you want about your medical history? Don't they ask for any forms so you have to go to your old doctor and bring your records?

[Medium Drink Of Water]

Hey Medium Drink,

So if you were to do scar revision over again, would you just go directly to a burn specialist and do whatever he says?

I'm wondering for people who do internal femurs if it is just better to leave the nail in there for the rest of their life.

No, I would've never gone to the burn specialist.  I should've left the osteotomy sites alone like the plastic surgeon said to.

If the nail isn't bothering you and you don't notice it, it is best to leave it in there.  The femur gets filled with fatty tissue by the time you're an adult; only kids have marrow in the femurs.  So it's not really hurting anything by being in there.

"I'd go back to Serbia and not mention the mental health medications"

I've never taken mental health medications but I am thinking of seeing a doctor to ask about adderall and ADHD.

So you can just go to a foreign doctor and tell them whatever you want about your medical history? Don't they ask for any forms so you have to go to your old doctor and bring your records?

Yeah, you can probably just tell them whatever you want, especially in less developed countries.  Nobody asked for any medical records in China.  I don't think anyone would care about ADHD either way though.

[Cannibal]

As long as you get to 6'0 then knee pain isn't a big deal.

[Taller]

As long as you get to 6'0 then knee pain isn't a big deal.

What's the big deal with 6'0? It's just an arbitrarily assigned number representing a measurement at the end of the day. Many people on this board will never be 6'0 unless new technology comes along. As long as they are happy with their heights, that is all that matters.

[BilateralDamage]

What's the big deal with 6'0? It's just an arbitrarily assigned number at the end of the day. Many people on this board will never be 6'0 unless new technology comes along. As long as they are happy with their heights, that is all that matters.

I will be 100% happy with myself as long as I'm at least average.  And the average is far from 6', but obviously Cannibal speaks for everyone. 

[Taller]

obviously Cannibal speaks for everyone. 

Lol. So true. We are blessed that he is willing to share his wisdom and talent of speaking for all men and women with us for free. Cannibal for president!

[Taller]

Also, dear Cannibal,

Since you're already like 5'9, why don't you just wear stilettos all the time for those precious three inches that you need more than all the 5'5 people here. Sure you'll look feminine and have knee problems, but it won't matter because you'll be 6'0!

[ChrisIsaak]

I agree with Cannibal. Although 6'0 is an arbitrary number, being taller and feeling at peace with yourself at the end of the day is worth all the permanent physical pain, if any. I just don't understand why physical pain scares so many people off. You want something, you get it. There was this Turkish guy in a local forum who constantly moaned and bitched about his desire to do LL but how scared he was that he'd die. At the end he didn't do it. It was a pathetic sight. I hope he doesn't continue torturing himself for his entire life.

[kneehowguys]

1. Does scar surgery still make a significant difference even if you get internal femurs?

2. So... they cut the scar out of your body? Doesn' that create another scar? I don't understand.

3. What are some bad things that can happen if you leave the nail in you. Will leaving it in there for many years make it dangerous to take out later in life if it causes problems?

4. What other costs of the operation people might not think of? I never thought of rogaine/propecia until hair started receding. Never thought of scar surgery until I read this forum. Never thought of leg muscle release or exogen or any of that..

[Medium Drink Of Water]

1. No, with internal femurs the scar surgery is pretty unnecessary because there's minimal scarring.
2. They cut a big, ugly scar out of your body and sew it up so you have a little white line instead.
3. I'm not aware of anything bad that can happen from leaving the nail in there.  Most western doctors think it's safer to leave the nail in than to have a surgery to remove it.  If, for some reason, you do need to take it out later in life, then it is a little more risky just like all surgeries on older people get riskier.
4. I haven't encountered any other unexpected costs that haven't already been mentioned on the forum.