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[Unknown]

As topic. Cost wise and pain level/complications wise.

[Masteryourlife]

Femur (tibia is not even safe at 6cm,this alone makes femur better )
Cost is less , recovery is faster .

Heard that chances of PE are higher on femur but other then this and maybe stretching pain..femur has all the others benefits .

[ReadRothbard]

6-7 cm (or 20% of your initial bone length) is generally considered the limit on your tibias, while femurs are roughly 7.8-8 cm (again, 20% of your bone length). Assuming you have longer femurs than your tibias, femurs would be the best option.

[SuchLL]

You may not be able to reach 6 cm on tibias, but 5 cm tibias will probably still make you look taller than 6 cm femurs. However there’re some studies showing significant correlation between increasing tibia femur ratio and knee arthritis. So tibias will make you look taller, but femurs are safer.

[LL2022]

How about someone with naturally short tibias? I have a self-measured tibia-femur ratios of around 0,77. Infact most people of East Asian ethnicity tend to have shorter tibias according to Dr Lee.

Furthermore, tibia is actually quite alot cheaper if you go with LON/LATN/externals compared to the internal nail options. Most surgeons will not even do external fixators on femurs for safety reasons while external fixators on tibias is a old and accepted method.

[Alija2]

You may not be able to reach 6 cm on tibias, but 5 cm tibias will probably still make you look taller than 6 cm femurs. However there’re some studies showing significant correlation between increasing tibia femur ratio and knee arthritis. So tibias will make you look taller, but femurs are safer.

Do you have a link to such a study?

[Sambollio]

6-7 cm (or 20% of your initial bone length) is generally considered the limit on your tibias, while femurs are roughly 7.8-8 cm (again, 20% of your bone length). Assuming you have longer femurs than your tibias, femurs would be the best option.

To be clear though 20% is generally the absolute limit for doctors that are responsible, 15% would be considered “safe”.

[Michael J. Assayag, MD]

Do you have a link to such a study?

right here:

https://pubmed.ncbi.nlm.nih.gov/26398436/

[Jake24]

You may not be able to reach 6 cm on tibias, but 5 cm tibias will probably still make you look taller than 6 cm femurs. However there’re some studies showing significant correlation between increasing tibia femur ratio and knee arthritis. So tibias will make you look taller, but femurs are safer.

what about 7-8 cm on femurs? will it make u look taller than 5cm tibias?

[Stretch]

right here:

https://pubmed.ncbi.nlm.nih.gov/26398436/

So increasing the Tibia length (bilateral) only is likely to promote arthritis in the hip and knee, however increasing the Femur length (bilateral) only has no known long term issues?

[ReadRothbard]

To be clear though 20% is generally the absolute limit for doctors that are responsible, 15% would be considered “safe”.

I think it generally depends on the person, but 15% is considered rather conservative and will allow for much faster return to pre-op athletics.

[Sorcerer]

Of course tibias cuz tibia can gain you a better proportion and tibias cost you at lower prices.

[zaozari]

So increasing the Tibia length (bilateral) only is likely to promote arthritis in the hip and knee, however increasing the Femur length (bilateral) only has no known long term issues?

NO! The study was made on 1152 CADAVERIC femurae and tibia, from common people, NOT subject to CLL, without any "increasing" in bone lenght whatsoever.
It's interesting and apparently the first study to evaluate ORIGINAL proportion T/L in regards to arthritis.
But it does not compare in any way the amounts of lengthening in the two bones with afterwards arthritis. It is not a study on the correlation of any elongation whatsoever (either tibia or femur). It's not correct to directly  extrapolate the study to CLL.
Why? For several reasons, one of which is that short people usually have shorter tibias also in relative terms. So the study could have concluded also, or INSTEAD, that taller people have more arthritis in certain parts of the body (as other studies also show), due to any reason related to that and not only higher proportion of tibia/femur (eg: taller = heavier weight; bigger tibias AND femurs,...). Big bodies exert more pressure on certain articulations, like knees (and are more prone to some heart diseases, BTW, for example).
Furthermore, one has to take into account diferences in proportions among individuals, populations and diferent initial height, very relevant for the evaluation of proportions, safety, and deciding which bone and by how much amount to lenghten.
Dr. Assayag has a big scientific and academic "authority" but I am also used to read and interpretate scientific articles. He prefers clearly to do femurs elongation and it's simpler indeed.
But tibias may be saffer in several important circumstances, for example, clots, if formed there, are less prone to make all the way up to the lungs, heart or brain and cause lethal thrombosis.
To sum up, a lot of things must be taken into consideration when planning CLL. In general terms, tibias are better for proportions.
This study adds relevant information but it isn't in any way a demonstration that "femurs are better ".

[zaozari]

Of course tibias cuz tibia can gain you a better proportion and tibias cost you at lower prices.

It's correct.
And, if the doctor is good, if you are young, healthy and if things are going ok during the process (lenghtening, consolidation, physiotherapy, etc.), you can even attempt easily 7,5 cm. You should, in that case, however, put even more emphasis on Achilles tendon elongation in physiotherapy or /and be prepared for a possible small surgery to elongate it, if still needed.
There is not a standard safety limit of 5 or 6/6,5 cm for tibia lenghtening agreed by science or experience; but of course those figures are saffer and are frequently seen because past that Achilles tendon elongation may be needed and it is becoming "tradition" (no space here for more) to elongate tibias less and femurs more (even if emphasising "disproportion"). But 10/15 years ago, standard CLL common protocol was doing tibias only, and by 3 inches (7,5 cm), even up to 10 cm (again, tibias only and if a series of conditions was fulfilled).

[SuchLL]

NO! The study was made on 1152 CADAVERIC femurae and tibia, from common people, NOT subject to CLL, without any "increasing" in bone lenght whatsoever.
It's interesting and apparently the first study to evaluate ORIGINAL proportion T/L in regards to arthritis.
But it does not compare in any way the amounts of lengthening in the two bones with afterwards arthritis.

However after we’re fully or almost fully recovered from CLL, we’re no different from common people, or at least we should have the same or even greater risks of arthritis than common people. For this reason I think this study applies to us too. I’m not saying the conclusion of the study is correct. It’s just a potential risk or adds more information like you said. I’m doing tibias and at 4.5 cm so far. I still have good flexibility and feel I should be able to reach 7 or 8 cm if I want. However such studies about potential issues with tibia femur ratio concerned me. And years ago Dr Paley also said the safe limit for tibia was 6.5 cm (and now it’s 5 cm because most of his patients can only get to 5. Maybe internal nails can’t give the same result as externals). I’m not sure if I should be greedy and try to get to 8… or should just do 6.5 cm. I did 8 cm on femurs last year.

[zaozari]

However after we’re fully or almost fully recovered from CLL, we’re no different from common people, or at least we should have the same or even greater risks of arthritis than common people. For this reason I think this study applies to us too. I’m not saying the conclusion of the study is correct. It’s just a potential risk or adds more information like you said. I’m doing tibias and at 4.5 cm so far. I still have good flexibility and feel I should be able to reach 7 or 8 cm if I want. However such studies about potential issues with tibia femur ratio concerned me. And years ago Dr Paley also said the safe limit for tibia was 6.5 cm (and now it’s 5 cm because most of his patients can only get to 5. Maybe internal nails can’t give the same result as externals). I’m not sure if I should be greedy and try to get to 8… or should just do 6.5 cm. I did 8 cm on femurs last year.

Yes, I understand your concerns and all data may be of interest.  It's a pitty that apparently that study is the single one so far dealing with T/F proportion.
If I may give an opinion (this is my provisional conclusion for myself based on everything I consulted so far) about your lenghtening amount on tibias, I would be "greedy" enough until 7 or even 7,5 cm IF the conditions I outlined above apply, if physiotherapy is relatively intense, specially lenghtening of the Achilles tendon, if you are young and, of course, if everything else keeps going on ok in the process. As I already said, years ago, 7,5 cm was kind of standard and up to 10 cm, with Ilizarov's frames, so 5 cm is really not a "biological" limit. But of course 5 cm are theoretically saffer than 7,5 cm.

[SuchLL]

Yes, I understand your concerns and all data may be of interest.  It's a pitty that apparently that study is the single one so far dealing with T/F proportion.
If I may give an opinion (this is my provisional conclusion for myself based on everything I consulted so far) about your lenghtening amount on tibias, I would be "greedy" enough until 7 or even 7,5 cm IF the conditions I outlined above apply, if physiotherapy is relatively intense, specially lenghtening of the Achilles tendon, if you are young and, of course, if everything else keeps going on ok in the process. As I already said, years ago, 7,5 cm was kind of standard and up to 10 cm, with Ilizarov's frames, so 5 cm is really not a "biological" limit. But of course 5 cm are theoretically saffer than 7,5 cm.

Maybe Paley is just more strict so he stops most of his patients at 5 cm, or Ilizarov frames allow you to add more height safely than internal nails. I’m still a bit concerned about going over 6.5 cm but I’ll consider 7.5 cm if I pass their examination. Thanks for your input!!

[Dexter5729]

As topic. Cost wise and pain level/complications wise.

imo for look wise, 6cm on tibas looks better aesthetically. Big Calves are beautiful, it depends on your femur tibias ratio too

[pandemic_exploiter]

I think femur looks better because it lets you pack more muscle on your frame. Quads are the largest group of muscles, and you will get larger total size by returning post-LL femurs to their pre-LL width

[ReadRothbard]

I think femur looks better because it lets you pack more muscle on your frame. Quads are the largest group of muscles, and you will get larger total size by returning post-LL femurs to their pre-LL width

On a side note: keep in mind that lengthening femurs will make squats harder, given the longer lever arm.

[pandemic_exploiter]

On a side note: keep in mind that lengthening femurs will make squats harder, given the longer lever arm.

Oh man looking forward to that...lol

[zaozari]

As topic. Cost wise and pain level/complications wise.

I've been making some research on this. Comparing opinions and criteria of different, competent, doctors, it seems there is some logic in that recommended maximum amount in tibias should not exceed 5 cm with nails and 7 cm or even a bit more with externals (subject to probable need of Aquilles  tendon lenghtening in this last case). Regardless of this, all cases must be individually evaluated.
Note that this is not a scientific "conclusion" found explicitly. But it's the only possible conclusion when you read articles from diferent, very experienced doctors and using diferent methods.

[ReadRothbard]

I've been making some research on this. Comparing opinions and criteria of different, competent, doctors, it seems there is some logic in that recommended maximum amount in tibias should not exceed 5 cm with nails and 7 cm or even a bit more with externals (subject to probable need of Aquilles  tendon lenghtening in this last case). Regardless of this, all cases must be individually evaluated.
Note that this is not a scientific "conclusion" found explicitly. But it's the only possible conclusion when you read articles from diferent, very experienced doctors and using diferent methods.

The rule of thumb I’ve seen supported by research is that you should never lengthen more than 20% of your initial bone length—15% if you want to be extra safe. I plan to do about 17%, personally.

[Highest]

The rule of thumb I’ve seen supported by research is that you should never lengthen more than 20% of your initial bone length—15% if you want to be extra safe. I plan to do about 17%, personally.

Do you have any links for this research?

[ReadRothbard]

I don’t atm, but I’ll get back to you.

[Height Journey]

Do you have any links for this research?

Interview from Dr Assayag by Cyborg4Life, starting at 21:20

https://www.youtube.com/watch?v=mxWQ1jOZuio&t=1280s

[ReadRothbard]

Here’s a study: https://jorthoptraumatol.springeropen.com/articles/10.1186/s10195-019-0541-3