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[MakinItHappen]

I am 5'8 and I've been reading around that the most wisest increase to make if you are going to do it, is 5cm. Which is just marginally under 2 inches and that would take me to only marginally under 5'10 and probably enough to make a massive difference for me.

I know many people did 7cm and seem pretty content, but are there restriction you feel to what you can do? What sort of sports do you play and how do you fare in comparison to what was before? And do you train legs in the gym? What's that like? Are you restricted in any severe way? Or are we simply talking a little bit of pain here and occasionally there when you go high impact?

Also what did you get in terms of ratio from femur to tibia? I've heard anyone getting more than 2cm on Tiba is increasing their probability for complications and/or restrictions going forward?

Sorry about all the questions, only I am still fairly new to this

[ghkid2019]

Nothing is guaranteed, but less is obviously better. 5cm on femurs seems very modest and I'm confident you'll regain most of your mobility back. I know long femurs make squatting hard.

Tibias ideally should be less than 4 or 5cm. If you want to go past that you will probably feel a tight Achilles.

Please note someone very recently posted that they went from 5'8 to 5'10 and they regretted it, because they felt nothing changed and still had height insecurities since 2 inches wasnt enough for them. Perhaps you should consider this anecdote to determine if you want to do 5cm or do more or do less or forget about the surgery as a whole.

[MakinItHappen]

Nothing is guaranteed, but less is obviously better. 5cm on femurs seems very modest and I'm confident you'll regain most of your mobility back. I know long femurs make squatting hard.

Tibias ideally should be less than 4 or 5cm. If you want to go past that you will probably feel a tight Achilles.

Please note someone very recently posted that they went from 5'8 to 5'10 and they regretted it, because they felt nothing changed and still had height insecurities since 2 inches wasnt enough for them. Perhaps you should consider this anecdote to determine if you want to do 5cm or do more or do less or forget about the surgery as a whole.

Thank you very much for the insight dude.

So you're saying I can get 5cm added exclusively to just the femurs and the tibias don't even have to be touched? Yeah I can easily comprehend how squatting would be tricky to get around with so much work done on the femurs.

I've always considered anything under 5'10 to be "manlet" and I know that makes it only 2 inches, but it does feel to be a lot in-terms of the difference. So it interesting to me that this guy still feels insecure about his height. Would you be able to point me in his direction on this forum?

Is an increase to 6cm or 7cm enough to increase the probability of restrictions/limitations by a much greater margin? You see it's very easy to slip into the mindset of; "oh it's only 1cm" and so then if it's only 1cm, why not another and then why not another after that? lol you see what I mean?

My initial plans were 7cm and 3 inches, however after careful consideration and quite a bit of reading, I've come down. I can probably see how he feels no different. As it would make sense. You build-up for something like this and believe it's going to be life-changing and then yet it's only 2 inches and while it does make a difference, it is only a subtle one and you are still not "tall", just more average.

I am incredibly active. I've been training in the gym pretty much all my life and fairly sporty too. Tennis mainly. So my first concern is intense physical activity. Not just mobility, but high intensity sport/activity. I am just absolutely concerned af that if I go 7cm and even 6cm I could be crossing that fine-line which will mean I cannot adjust the biomechanics enough to mean I wouldn't be restricted.

[Michael J. Assayag, MD]

There’s no guarantee. Although this is cosmetic limb lengthening, this is still medicine and complications happen. In the best hands. It’s the nature of the game. Even the best football / basketball /hockey/cricket team loses games sometimes. That’s just how it is.


what will increase your odds is to have a surgeon who knows what he’s doing , who will guarantee FOLLOWUP with Xrays, physical examination, and will perform careful troubleshooting of problems.
The last thing you want is a surgeon that dismisses problems  because he is shunning complications.

Being committed to the process will also increase your odds . My most successful patients have been committed to daily Physical therapy for anywhere between 1.5 hours to 3 hours. That does not mean you need to be at the therapist’s clinic every day, but you
need to commit to stretching on your own, every day. For 4 to 6 months, your limb lengthening should be your priority.

You want to increase your odds? use a brace to stretch at night as well. Keep an additive device handy. Don’t believe sleazy marketing . Keep an assistive device handy.

I was talking to a Nuvasive (Precice/stryde manufacturer)  engineer today as I periodically do. Even THEY don’t recommend ever getting rid of an assistive device during the whole lengthening period until at least 2 cortices of bone are fully healed. Be wary of sleazy marketing!!

If you guys only knew how often we see patients limp into our office after limb lengthening performed all over the world. There are mistakes i see surgeons make ALL the time , for which patients show up to my office of Janet Conway’s office:

1)Failure to release the iliotibial band for a femur lengthening will lead to SEVERE abduction contracture, subluxation of the knee, knee flexion contractures.

2) failure to use blocking screws in a tibia lengthening will lead to a flexion /valgus deformity

3) failure to fix the proximal tibio-fibular joint while lengthening will lead to premature consolidation of the fibula regenerate, fibular head pull down, and TERRIBLE knee flexion contractures!

4) failure to recess the gastrocnemius.—> equinus ans knee contractures
5) failure to release the common peroneal nerve when symptoms of peroneal nerve paralysis or neuritis appear (i do it prophylacticslly for all tibia lengthenings)
6) failure to do percutaneous fasciotomies of the anterior and lateral compartment increases the risk of compartment syndrome.

finally 7) , failure to use rotational markers during the initial surgery leads to rotational deformities, knee pain, hip pain. That’s a noob move!


hoever you pick , make sure your surgeon knows what they are doing. That’s what will increase the odds that you’ll recover as much lower extremity function as possible.

hope this helps


Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
massayag@lifebridgehealth.org
@bonelengthening on Instagram

[Highgains]

Dr Assayag regarding

6) failure to do percutaneous fasciotomies of the anterior and lateral compartment increases the risk of compartment syndrome.

Do you do the fasciotomies prior to any tibial lengthening or do you test for chronic exertional compartment syndrome after the lengthening has occured and then perform the surgery? In this thread

http://www.limblengtheningforum.com/index.php?topic=63997.0

Someone asked Dr Giotakis about compartment syndrome
This was his response:

Thank you for your interest in Athens Bone & Joint Reconstruction center. Apologies for the delay in our response, the technical part of your questions had to be answered directly by Dr Giotikas.  Answering your questions:
1. During surgery we try to minimize bleeding in the calf by using tranexamic acid and by utilizing  atraumatic techniqe when making the osteotomy of the bone. We do not routinely perform prophylactic fasciotomy during the index surgery, because fasciotomies might have their own risks. If you are considering to have prophylactic fasciotomies, Dr Giotikas is happy to discuss the matter with you and make a joined decision.

2. The diagnosis of compartment syndrome is straightforward in an alert patient (not sedated or unconscious). The plan of action is to go back to theatre for emergency fasciotomies within the next hour from diagnosis. Closure of fasciotomy wounds (delayed primary or with skin graft) is taking place a few days later, when safe. The incidence of compartment syndrome is reported to be approximately 2-9%, based on studies with mainly tibia fractures.
Compartment syndrome risk and other potential risks and the measures we take to minimize them are thoroughly discussed during the pre-operative consultation with Dr Giotikas.
We hope you found this response useful and we remain at your disposal for any further information ad advice.

What did you think about this approach?

[Michael J. Assayag, MD]

We perform prophylactic fasciotomies in all patients undergoing tibia lengthening in addition to the use of tranexamic acid. it is performed through the same incision  we do the tibia osteotomy. it does not add much time to the surgery nor any new scar. It greatly decreases the risk of  compartment syndrome due to swelling following tibia breakage.

The solution for established compartment syndrome is to do extensive fasciotomies medially and laterally using full length medial and lateral incisions, which results in extensive scarring. In our opinion, the benefit of the prophylactic fasciotomy greatly outweigh the potential risk , especially if done properly.

So pick your poison: no new scar and extremely low potential for fasciotomy related complication (hematoma? maybe?), vs 2-9 % compartment syndrome risk reported in the trauma littérature (likely much less in the context of a controlled osteotomy of the tibia) requiring the need for extensive medial and lateral cuts? I know what I am choosing as a surgeon

Don’t get me wrong: The goal is not to get into an argument by proxy with Dr. Giotikas, as he has chosen the method that works well in his hands and for his patients

finally, Although  we discuss the risk of such a dramatic complication as compartment syndrome pre  operatively, it still breaks our heart when it happens to a patient under our care . Thus I take every measure I can to mitigate that risk

[2020hope]

We perform prophylactic fasciotomies in all patients undergoing tibia lengthening in addition to the use of tranexamic acid. it is performed through the same incision  we do the tibia osteotomy. it does not add much time to the surgery nor any new scar. It greatly decreases the risk of  compartment syndrome due to swelling following tibia breakage.

The solution for established compartment syndrome is to do extensive fasciotomies medially and laterally using full length medial and lateral incisions, which results in extensive scarring. In our opinion, the benefit of the prophylactic fasciotomy greatly outweigh the potential risk , especially if done properly.

So pick your poison: no new scar and extremely low potential for fasciotomy related complication (hematoma? maybe?), vs 2-9 % compartment syndrome risk reported in the trauma littérature (likely much less in the context of a controlled osteotomy of the tibia) requiring the need for extensive medial and lateral cuts? I know what I am choosing as a surgeon

Don’t get me wrong: The goal is not to get into an argument by proxy with Dr. Giotikas, as he has chosen the method that works well in his hands and for his patients

finally, Although  we discuss the risk of such a dramatic complication as compartment syndrome pre  operatively, it still breaks our heart when it happens to a patient under our care . Thus I take every measure I can to mitigate that risk

Sorry don't mean to highjack the thread but I have a related question for Dr
 Michael.

Dr. Michael, what are the various ways in which a patient could completely lose his or her legs by doing CLL?

[ghkid2019]

I don't think anyone has every lost their legs completely, at least from everything I've ever seen about this surgery. The closest would probably be non union in the gap of the bone stretching which would require a bone graft from else where to fix. Limb lengthening techniques are actually used to salvage bones considered "loss beyond repair", so I highly doubt anyone will lose their limbs or face a problem and be unable to fix it. The next closest thing would be nerve damage. If you stretch the bone too fast or too much you can have nerve damage which can take years to recover from, and you can lose the function of your legs muscle or your foots movements. Usually this won't happen if you don't try to lengthen over reasonable amounts by doctors opinions and at the recommended rate

[Michael J. Assayag, MD]

Sorry don't mean to highjack the thread but I have a related question for Dr
 Michael.

Dr. Michael, what are the various ways in which a patient could completely lose his or her legs by doing CLL?

Highly unlikely... We use limb lengthening techniques for salvage purposes medically, whereas other surgeons alternative is amputation...

The various ways would be to really drop the ball multiples times again and again and again.

Unrecognized femoral arterial injury that goes unrepaired.

complete Laceration of the sciatic nerve. (somewhat salvageable)

Unrecognized compartment syndrome (even this is salvageable)

Go see a surgeon who knows what he’s doing and none of those should happen.

[Improving]

Dear Doctor Assayag,

At first, thank you so much for being active on this forum by giving guidance. I totally agree, some doctors seems to advertize this market and misleading potential patient.

Thus, for us, future patient, it is difficult to have a clear understanding of what to expect.
This forum is great but still not enough as it is only individual experience and after I read many testimonies, it seems that the experience of each varies a lot with some making it really easy and other all the contrary !

I have read your bio and that you have been involved in many surgeries with stryde and seen a lot of patients.
In your experience, for Stryde femur for a reasonnable amount (max 6cm), what should expect the patient in term of timeline (given that the patient is doing the rehab seriously and is young and active patient as we mostly are in this forum)?

I know each patient is different but still in average and in your experience (reality no advertising of course), when the patient should be able to come back to a normal life (basic activities : walk normally long disrance, go up and down stairs...)?
And when should be able to come back to an active life style (hiking, active sports..)

I am asking because as I said, between the advertising of some doctors and the individual experience of person, it is still difficult for me to get a clear timeline for an average patient using femur stryde (reasonnable amount)?

 
On my side, I am planning to do femur stryde for max 6cm in the coming months and I am in the process of choosing a doctors as well as making sure this surgery is really for me.
Thus, your input could be very valuable !

Thank you

[Michael J. Assayag, MD]

Dear Doctor Assayag,

At first, thank you so much for being active on this forum by giving guidance. I totally agree, some doctors seems to advertize this market and misleading potential patient.

Thus, for us, future patient, it is difficult to have a clear understanding of what to expect.
This forum is great but still not enough as it is only individual experience and after I read many testimonies, it seems that the experience of each varies a lot with some making it really easy and other all the contrary !

I have read your bio and that you have been involved in many surgeries with stryde and seen a lot of patients.
In your experience, for Stryde femur for a reasonnable amount (max 6cm), what should expect the patient in term of timeline (given that the patient is doing the rehab seriously and is young and active patient as we mostly are in this forum)?

I know each patient is different but still in average and in your experience (reality no advertising of course), when the patient should be able to come back to a normal life (basic activities : walk normally long disrance, go up and down stairs...)?
And when should be able to come back to an active life style (hiking, active sports..)

I am asking because as I said, between the advertising of some doctors and the individual experience of person, it is still difficult for me to get a clear timeline for an average patient using femur stryde (reasonnable amount)?

 
On my side, I am planning to do femur stryde for max 6cm in the coming months and I am in the process of choosing a doctors as well as making sure this surgery is really for me.
Thus, your input could be very valuable !

Thank you

You are most welcome!

The young and otherwise healthy patient looking for 6cm (60mm) can look at the following timeline as it pertains to return to activities:
Start lengthening on day 5 after surgery (latency period) at a rate of 4x 0.25mm/day (1mm/ day)
it means that the very fastest you can get to full length is 65 days.

It is not uncommon to slow down lengthening for quality of regenerate, to prevent contractures from settling and giving the chance to eliminate them, or if symptoms of nerve traction injury start appearing. We initially slow down to 0.25 x3 times per day (0.75mm/day), and sometimes , but more rarely, to 0.5mm/day. Remember, slow and steady wins the race. The priority is safety, and avoidance of complications.

Realistically, for 6cm, you would be looking at anywhere between 65 to 90 days of lengthening.
Depending on your starting weight, you are allowed weight bearing as per tolerance (and if i may add, always preferably with assistive devices).

Remember, the forces of walking is up to 2x body weight, and climbing stairs up to 4x body weight.

Most patients by 6 months have mostly healed regenerate and walk without assistive devices. Impact activities are resumed anywhere between 6 to 9 months. (which really is no different than following an ACL reconstruction!!!)

By one year, you can expect to be back to full activities. (depending on your dedication and your pre operative physical condition,  return to pre operative athletic levels may take longer than that).


remember to manage your expectations.: Slow and steady wins the race. If you expect to be back to your pre surgical levels by 6 months, you can only be disappointed. If you expect longer recovery time, then you increase your satisfaction.


I hope this helps! Let me know if that does not fully answer your question and I will add more details.

 Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
massayag@lifebridgehealth.org
@bonelengthening on Instagram

[lang319]

Highly unlikely... We use limb lengthening techniques for salvage purposes medically, whereas other surgeons alternative is amputation...

The various ways would be to really drop the ball multiples times again and again and again.

Unrecognized femoral arterial injury that goes unrepaired.

complete Laceration of the sciatic nerve. (somewhat salvageable)

Unrecognized compartment syndrome (even this is salvageable)

Go see a surgeon who knows what he’s doing and none of those should happen.

Dear Dr Assayag，What is the chance of compartment syndrome in femoral surgery?

[Michael J. Assayag, MD]

Slim to none, especially if done in a supine position . Never seen it reported in any series and it has never happened in our  center.

I have never seen anyone do this surgery on a traction table. But if anyone did it that way, there is a theoretical risk of compartment syndrome for the other leg. Once again: i have never seen or heard of any surgeon doing the surgery in such a way.

[MakeMeTallAF]

You are most welcome!

The young and otherwise healthy patient looking for 6cm (60mm) can look at the following timeline as it pertains to return to activities:
Start lengthening on day 5 after surgery (latency period) at a rate of 4x 0.25mm/day (1mm/ day)
it means that the very fastest you can get to full length is 65 days.

It is not uncommon to slow down lengthening for quality of regenerate, to prevent contractures from settling and giving the chance to eliminate them, or if symptoms of nerve traction injury start appearing. We initially slow down to 0.25 x3 times per day (0.75mm/day), and sometimes , but more rarely, to 0.5mm/day. Remember, slow and steady wins the race. The priority is safety, and avoidance of complications.

Realistically, for 6cm, you would be looking at anywhere between 65 to 90 days of lengthening.
Depending on your starting weight, you are allowed weight bearing as per tolerance (and if i may add, always preferably with assistive devices).

Remember, the forces of walking is up to 2x body weight, and climbing stairs up to 4x body weight.

Most patients by 6 months have mostly healed regenerate and walk without assistive devices. Impact activities are resumed anywhere between 6 to 9 months. (which really is no different than following an ACL reconstruction!!!)

By one year, you can expect to be back to full activities. (depending on your dedication and your pre operative physical condition,  return to pre operative athletic levels may take longer than that).


remember to manage your expectations.: Slow and steady wins the race. If you expect to be back to your pre surgical levels by 6 months, you can only be disappointed. If you expect longer recovery time, then you increase your satisfaction.


I hope this helps! Let me know if that does not fully answer your question and I will add more details.

 Dr. Michael J. Assayag, MD. FRCSC
Limb Lengthening and Reconstruction Surgeon
International Center for Limb Lengthening of Baltimore
http://www.heightrx.com
https://www.limblength.org/conditions/short-stature/
massayag@lifebridgehealth.org
@bonelengthening on Instagram

Dr. Assayag,

Is it possible to lengthen the femur at .5 mm/day (aka 2 x .25mm) for the entire period of lengthening? Or does that risk premature consolidation?

I ask this because my goal is to do 5 cm femur internal Stryde, and to make a full athletic recovery. I've read that the main issue is usually with soft tissues, and that the slower you lengthen, the easier it is for soft tissues to adapt. Time is not a big deal for me, only my health.

Also, when it comes to soft tissues, from my understanding they undergo distraction histogenesis. Does this mean that all soft tissues (skin, nerves, muscles etc.) will grow along with the bone, or will there be some permanent stretching even with only 5 cm? Will this have any effect on athleticism long term (10-20+ years after lengthening)?

And lastly, with the internal femur method of Stryde, is it possible to prevent/treat knocked knees (I believe it's called valgus deformity)? Does lengthening femurs 5 cm put you at higher risk for arthritis? I've read that since the hips are wider than the knees, lengthening places more horizontal pressure on the knee joints (such as with knock knees) which can lead to arthritis.

Thank you for your time Dr. Assayag, your input is very valuable here

[a]

Also, when it comes to soft tissues, from my understanding they undergo distraction histogenesis. Does this mean that all soft tissues (skin, nerves, muscles etc.) will grow along with the bone, or will there be some permanent stretching even with only 5 cm? Will this have any effect on athleticism long term (10-20+ years after lengthening)?

This is an incredibly good question. I also want to know the answer.

[SpeedDialer]

"You want to increase your odds? use a brace to stretch at night as well. Keep an additive device handy. Don’t believe sleazy marketing . Keep an assistive device handy."

Thank you. What kind of brace and assistive device?

[Michael J. Assayag, MD]

"You want to increase your odds? use a brace to stretch at night as well. Keep an additive device handy. Don’t believe sleazy marketing . Keep an assistive device handy."

Thank you. What kind of brace and assistive device?

here we use custom made knee braces that provide a constant stretch over time.

Any kind of “turn buckle” brace will work. something like :
this would work but is not convenient for sleep.

https://www.jointactivesystems.com/products/jas-ez-knee-extension

 Hence why we custom make ours

In terms of effect. There are electomyographic changes that occur during even short lengthenings. However it is unclear what the long term effects on athleticism are. We have numerous patients who went back to regular physical activity. Maybe if you’re a professional sports player, if you don’t want to take any chance, avoid limb lengthening until the end of your career.

If you’re a weekend warrior, you should be good.

[SpeedDialer]

Thank you.

1. When a patient does IT band release or gastro recession, do you think he should also do a nerve decompression at the same time in the respective areas?

2. What would you say if you were a patient and his doctor disagreed your view on this?

3. Basically, I imagine this situation:

Patient: "hey doc, why don't you a gastro recession prophylactically, I heard its good if you are doing more than 4 cm" 

Doctor: Nah that's unnecessary

Patient: Won't things hurt more for me if you don't do it? And this other doctor says its good, how much does it cost? And how much does a nerve compression cost too?

Doctor: You want me to do all these things?

What if I pressure a doctor into doing something he doesn't want and he makes a mistake? or are these simple enough that won't be

[184dream]

Hey speed. There is a video where dr paley said that he doesnt do gastro resection but does the other two watch the video instead.

[Ronman]

I am a fellow 5'8

5'8 to 5'10 doesn't seem worth it for me as well, if it costs 80k and 3 months of my life atleast

If 3 inches was considered as safe as 2 inches is, I'd seriously consider it.

If you see it as 'worth it' though, then by all means go ahead

[MakinItHappen]

I am a fellow 5'8

5'8 to 5'10 doesn't seem worth it for me as well, if it costs 80k and 3 months of my life atleast

If 3 inches was considered as safe as 2 inches is, I'd seriously consider it.

If you see it as 'worth it' though, then by all means go ahead

5'8 to 5'10 is probably the biggest LIFE TURNING jump that you can make. The difference is VERY significant, especially after putting shoes on which will take you to 5'11. Add 1 inch insole lifts into the equation and you have a 6ft man, give or take.

[Sambollio]

5'8 to 5'10 is probably the biggest LIFE TURNING jump that you can make. The difference is VERY significant, especially after putting shoes on which will take you to 5'11. Add 1 inch insole lifts into the equation and you have a 6ft man, give or take.

I’d disagree with this because (at least in the US) you went from slightly below average to slightly above average. I’d guess going from 5’6” which is considered “short” to “very short” increasing to 5’8” which most would consider a relatively normal male height. 5’5 to 5’7 would also make a huge difference I think.

[Sambollio]

Posting after Dr. A feels a bit silly but here is my 2 cents. Nothing is guaranteed, obviously, but it’s important to remember the flat cm amount on its own means nothing. What does matter is what percentage of the original bone length you are lengthening by. For example if you are 5’1” and your femurs are 38 cm long, a 5cm increase is close to the recommended safe amount which is 15%. However for you, your femurs are likely close to 48cm (this may vary greatly, but speaking  hypothetically based on the average for your height) you are lengthening 10% leaving 2.2 cm less than what is still considered generally safe. Lol this is the cruel irony of Limb Lengthening, the taller you are, the safer it is…

From what I hear people experience subjectively is that 5cm is the turning point where things become exponentially more difficult every mm past that.

I can’t speak for sure but I think you might be disappointed with the results of 5cm. In the U.S. at least, you are still kinda in the “mediocre” height range where it’s not really positive or negative, you are just an average joe, 5cm will take you from the bottom of the average joe range to the top. I think the next tier of height is 5’11-6’0, the “ kinda tall” range aka a respectable male height. This is the point where your height goes from neutral to positive in the way people see you.

If you are 5’8 and some change, you can get to 5’11 with 7cm. At this height you are as tall as almost every guy who claims 6 foot, you might even be taller than a lot of “6 footers”. I promise 95% of men (in the US) that claim 6 foot are 5’10- 5’11. And every guy who is actually 6 foot claims 6’1-6’2 because they don’t want to be perceived as one of the 5’10-5’11 guys lol. Anyways that’s a random tangent but I wanted to say that if you get to that 5’11 height or close to it, you are 6 ft in basically everyone’s eyes.