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[Philosopher]

Recently, I've been reading articles related to extensive limb lengthening for patients primarily diagnosed with Achondroplasia and Hypochondroplasia. I've been thinking of sharing a few thoughts I've had.

According to article by Paley from 2021, the average lengthening was 27 cm for achondroplasia (12-40 cm) and 17 cm for hypochondroplasia (range 10-25 cm). It showed a mean increase of 26 cm (range 15-30 cm) for adolescent-onset. There were almost no noticeable short-term complications.

Since I haven't had the experience yet, I am genuinely curious what is preventing patients without any such conditions from reaching these goals with a little bit of hard work. (even in their adulthood; leaving proportions and low motivation completely aside and talking solely about bone healing and soft tissue adaption), if they have been documented as success by many similar studies. It seems these results completely obliterate the safe norms set by many surgeons (8cm, 6.5 cm for femurs and tibias respectfully). Some argue that it is the muscle structure of these specific patients are different that can relatively quickly adapt to change, but I find this lacking solid evidence (if you can provide some, it'd be appreciated). Additionally, this particular study casts doubts on the idea that 'the longer your bones, the more you can gain.' In my controversial opinion, the only thing that allowed for such gains was the strong determination of the patients as all of them pushed way beyond their limits to get closer to average height as possible.

What am I missing here?

[lessthanavg8300]

Recently, I've been reading articles related to extensive limb lengthening for patients primarily diagnosed with Achondroplasia and Hypochondroplasia. I've been thinking of sharing a few thoughts I've had.

According to article by Paley from 2021, the average lengthening was 27 cm for achondroplasia (12-40 cm) and 17 cm for hypochondroplasia (range 10-25 cm). It showed a mean increase of 26 cm (range 15-30 cm) for adolescent-onset. There were almost no noticeable short-term complications.

Since I haven't had the experience yet, I am genuinely curious what is preventing patients without any such conditions from reaching these goals with a little bit of hard work. (even in their adulthood; leaving proportions and low motivation completely aside and talking solely about bone healing and soft tissue adaption), if they have been documented as success by many similar studies. It seems these results completely obliterate the safe norms set by many surgeons (8cm, 6.5 cm for femurs and tibias respectfully). Some argue that it is the muscle structure of these specific patients are different that can relatively quickly adapt to change, but I find this lacking solid evidence (if you can provide some, it'd be appreciated). Additionally, this particular study casts doubts on the idea that 'the longer your bones, the more you can gain.' In my controversial opinion, the only thing that allowed for such gains was the strong determination of the patients as all of them pushed way beyond their limits to reach be as average height as possible.

What am I missing here?

This was probably done in several phases with years in between lengthenings.  I think I saw it in one of his presentation slides a while back.

[Philosopher]

Yes, I also thought about that, but I've seen studies that explicitly state they were able to reach these same gains in just one surgery for femur and tibia.

[lessthanavg8300]

Yes, I also thought about that, but I've seen studies that explicitly state they were able to reach these same gains in just one surgery for femur and tibia.

Not sure then....maybe its because they're children.  Then again people are doing 12CM with Becker pretty regularly.  But on the other hand the precice nail has a max of 8CM for a limit for a reason.  So yeah...hard to say.

[belowbelowavg]

Wats the reason?

[belowbelowavg]

Exactly, I'm gonna do 12 cm femurs and 8 cm tibias. Its just hard work and pain tolerance.

[Maison]

It is difficult to explain in simple terms, but such patients with congenitally extremely short legs may have the potential to stretch their muscles and tendons to standard lengths with ease.
In short, their muscles and tendons are loose and have a lot of room to stretch.　

[lessthanavg8300]

Exactly, I'm gonna do 12 cm femurs and 8 cm tibias. Its just hard work and pain tolerance.

Why dont you reduce this by 3cm on both segments.  8cm on tibias in particular is going to f-ck you up.  Medium talks on this forum regularly about how he wishes he did less.  9+5 is some serious height gain and youll probably make it out functional.

[Philosopher]

Why dont you reduce this by 3cm on both segments.  8cm on tibias in particular is going to f-ck you up.  Medium talks on this forum regularly about how he wishes he did less.  9+5 is some serious height gain and youll probably make it out functional.

I just get lowkey annoyed with comments like 'you'll absolutely regret it', 'it's a death sentence' and so on, without any detailed explanations whatsoever.  The fact is, as I presented, there are people who reached these gains. Could you please at least explain how exactly would he get 'f*cked up'? If you are claiming something, please make a solid case for it.

[Philosopher]

It is difficult to explain in simple terms, but such patients with congenitally extremely short legs may have the potential to stretch their muscles and tendons to standard lengths with ease.
In short, their muscles and tendons are loose and have a lot of room to stretch.　

Do you know any articles on it?

[lessthanavg8300]

I just get lowkey annoyed with comments like 'you'll absolutely regret it', 'it's a death sentence' and so on, without any detailed explanations whatsoever.  The fact is, as I presented, there are people who reached these gains. Could you please at least explain how exactly would he get 'f*cked up'? If you are claiming something, please make a solid case for it.

I provided you with an example on the exact comment you quoted.  MDOW did too much on his tibias (around 8CM) and hit a complication (I think it was tarsal tunnel but Im not sure) which he is dealing with many years later. He said he wishes he did less.  Another complication is ballerina foot.  8CM on your tibias is huge.  Thats like the safe limit for your femurs.

[Maison]

Do you know any articles on it?

https://boneandjoint.org.uk/article/10.1302/0301-620x.91b12.22418#rR2 This paper contains the following statement.

achondroplastic patients show increased ligament and joint laxity, their muscle length exceeding bone length before lengthening.

This seems to be a quote from Paley's article below.
https://sci-hub.hkvisa.net/10.1097/01241398-198801000-00018

[Philosopher]

https://boneandjoint.org.uk/article/10.1302/0301-620x.91b12.22418#rR2 This paper contains the following statement.

achondroplastic patients show increased ligament and joint laxity, their muscle length exceeding bone length before lengthening.

This seems to be a quote from Paley's article below.
https://sci-hub.hkvisa.net/10.1097/01241398-198801000-00018

Thanks. Do you know how would that be different to hypochondroplastic patients, if at all?

[Maison]

Thanks. Do you know how would that be different to hypochondroplastic patients, if at all?

I am not familiar with the difference between achondroplasia and hypochondroplasia, but since both seem to be FGFR3 gene problems, I would guess that the characteristics of short bones, increased ligament and joint laxity are similar.