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[Tempo]

As often it was mentioned on this forum maximal lengthening amount usually cant exceed 10-20% of segment length (for tibias usually 4-8 cm.), otherwise patient has big chance to become crippled. But can one big surgery be replaced with 2 small surgeries with big time pause to decrease risks?

For example if someone want to lengthen tibias for 9 cm (almost guaranted complications), can he at first do surgery for 5 cm, then wait 1-2-3 years and make second surgery for 4 cm? Will it be more safe than one big surgery? Will the second surgery be more dangerous than common 4-cm tibia surgery?

I know that dwarfs do several surgeries on one segment and get big height gain, but how it will work with initially healthy man?

[Medium Drink Of Water]

Most of the complications you're talking about won't be avoided by doing half and half in two surgeries no matter how far apart they are.  I used to be able to barely put my palms on the floor.  Now my palms are 3" off the floor when I try.

[Worzezterlire]

Yes and no.  Yes in the sense that you can have much fewer complications than doing it all at once.  For example there’s a small chance I may have to stop my femurs at 5cm, wait 6 months, and rebreak for the final 3cm.  But it’s looking less likely now.

But it doesn’t mean I can do 8cm in femurs, and then a few years later do another 8cm.  The muscles probably won’t ever return to “normal” before, so another 8cm would enter the cripple zone of lengthening.  The muscles won’t magically be ready to accept another 8cm after a few years.

[MakeMeTallAF]

You're right that it won't return completely to normal, but the purpose of spacing out the lengthening is to give the time for the muscle to recover as much as possible.

One of the reasons we have such a limit in lengthening (such as 5 cm) is because while our bones grow fast, our muscles cannot keep up. Lengthening 5 cm in 50 days is way too fast for soft tissues.

Theoretically if you could lengthen 0.1 mm/day without risk of preconsolidation, you would be able to lengthen much longer amounts because it is similar to the process your legs undergo during puberty (minus the bone break ofc)

[Worzezterlire]

You're right that it won't return completely to normal, but the purpose of spacing out the lengthening is to give the time for the muscle to recover as much as possible.

One of the reasons we have such a limit in lengthening (such as 5 cm) is because while our bones grow fast, our muscles cannot keep up. Lengthening 5 cm in 50 days is way too fast for soft tissues.

Theoretically if you could lengthen 0.1 mm/day without risk of preconsolidation, you would be able to lengthen much longer amounts because it is similar to the process your legs undergo during puberty (minus the bone break ofc)

It’s not quite the same process as under puberty otherwise I’d agree.  During puberty the bones are growing but so is everything else at a similar rate, muscles are being built and not stretched.  There’s controversy if lengthening the legs triggers any new muscle growth or if it just stretches existing muscles to near failure.  Most surgeons seem to think there’s some growth but a lot of just stretching.  Which means that a few years later you’ll still be “stretched” so it’s not as if you’re starting fresh.  I think even at 0.1mm a day this would probably be the case but that’s pure speculation

[MakeMeTallAF]

It’s not quite the same process as under puberty otherwise I’d agree.  During puberty the bones are growing but so is everything else at a similar rate, muscles are being built and not stretched.  There’s controversy if lengthening the legs triggers any new muscle growth or if it just stretches existing muscles to near failure.  Most surgeons seem to think there’s some growth but a lot of just stretching.  Which means that a few years later you’ll still be “stretched” so it’s not as if you’re starting fresh.  I think even at 0.1mm a day this would probably be the case but that’s pure speculation

Muscle and other soft tissues grow, not just stretch permanently. Look up distraction histeogenesis. Rozbruch and Paley both talk about this.

Yes the soft tissues stretch also, that is initially because the soft tissues cannot keep up with the rate of lengthening of the bone. However eventually the stretching force causes the soft tissues to grow. This is the same process which takes place in puberty. Your bones grow, and your muscles stretch intially (it's probably why you feel soreness when you're growing)- the stretching of the muscles causes them to grow.

The big difference is of course the rate of lengthening. I believe due to the fast rate of lengthening, the soft tissues never recover fully (lengthening too fast will cause scar tissue to form etc).

[Medium Drink Of Water]

It's not the same biological process, and the reason it's not the same isn't only because of the rate of lengthening.

[AimHigh]

I am with You, I am now 55 YO, maybe there has been some new cell growth (i.e thigh diameter is same post CLL), but even 5 years Post RFem. 5.3 cm (at 0.66mm/day) CLL I feel a lot of tension, and have reduced flexibility, and anterior pelvic  tilt.
I feel even more extreme tension in my 3 year post CLL 8cm stretched thigh.
I have also noticed my anteror Tibs become very tight now with excercise and inclines, I just walked 4 klm (at a fair paice) with some slight up/down and I had to rest twice (and inclined my legs to drain tension/fluid?) as both my anterior lower legs were very pumped, and the tops of my knees were getting tight (TFL/Patella Tendon?) - I don't think my walking will improve much more after 5 years of daily walks. 

[MakeMeTallAF]

It's not the same biological process, and the reason it's not the same isn't only because of the rate of lengthening.

What specifically is the difference? Growth hormone?

[Medium Drink Of Water]

What specifically is the difference? Growth hormone?

Yeah, there are hormones involved and it's all part of a system foregone genetic growth pattern.  In normal human development the bones don't grow in isolation and then pull fully formed muscles outward with them.