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Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity.

Song SH, Agashe MV, Huh YJ, Hwang SY, Song HR - Acta Orthop (2012)

Bottom Line: We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia.The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery.Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis.

View Article: PubMed Central - PubMed

Affiliation: Institute for Rare Diseases and Department of Orthopaedic Surgery, Seoul, Korea.

ABSTRACT

Background and purpose: Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia.

Methods: We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years.

Results: Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis.

Interpretation: Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence-especially when lengthening of more than 50% is attempted.

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Percentage growth in lengthening group L as compared to that in control group C. Percentage growth was determined from the ratio of the growth rate in group L divided by growth rate in group C.
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Figure 5: Percentage growth in lengthening group L as compared to that in control group C. Percentage growth was determined from the ratio of the growth rate in group L divided by growth rate in group C.

Mentions: The patients in group C showed a maximum growth rate at the start of follow-up at 8 years of age, which progressively decreased over the years and became less than 10 mm/year after 11 years of age, until skeletal maturity was reached at 16 years of age (Figure 4). There was no significant difference in the growth rate between groups at the time of initial follow-up and until 2 years after surgery (p = 0.5), but after that it fell drastically. 2 years after surgery, around 11 years of age, the difference in growth rates in the groups became statistically significant and the percentage growth was 54% relative to group C (Figure 5).


Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity.

Song SH, Agashe MV, Huh YJ, Hwang SY, Song HR - Acta Orthop (2012)

Percentage growth in lengthening group L as compared to that in control group C. Percentage growth was determined from the ratio of the growth rate in group L divided by growth rate in group C.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369156&req=5

Figure 5: Percentage growth in lengthening group L as compared to that in control group C. Percentage growth was determined from the ratio of the growth rate in group L divided by growth rate in group C.
Mentions: The patients in group C showed a maximum growth rate at the start of follow-up at 8 years of age, which progressively decreased over the years and became less than 10 mm/year after 11 years of age, until skeletal maturity was reached at 16 years of age (Figure 4). There was no significant difference in the growth rate between groups at the time of initial follow-up and until 2 years after surgery (p = 0.5), but after that it fell drastically. 2 years after surgery, around 11 years of age, the difference in growth rates in the groups became statistically significant and the percentage growth was 54% relative to group C (Figure 5).

Bottom Line: We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia.The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery.Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis.

View Article: PubMed Central - PubMed

Affiliation: Institute for Rare Diseases and Department of Orthopaedic Surgery, Seoul, Korea.

ABSTRACT

Background and purpose: Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia.

Methods: We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years.

Results: Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis.

Interpretation: Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence-especially when lengthening of more than 50% is attempted.

Show MeSH
Related in: MedlinePlus