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Author Topic: Dr Paley used to reccommend safe limit in tibias as 6.5cm  (Read 844 times)

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Highest

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Dr Paley used to reccommend safe limit in tibias as 6.5cm
« on: January 11, 2021, 11:35:23 AM »

https://paleyinstitute.org/centers-of-excellence/stature-lengthening/the-precice/#/

"The total height gain with two lengthenings is as high as 14.5 cm (8 cm in the femurs and 6.5 cm in the tibias). Greater length is not as well tolerated in the tibia and Dr. Paley highly recommends not to exceed 6.5 cm in the tibias, as it can lead to serious complications."

How long until the current 8cm femur is safe limit drops as well?
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Coeus

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #1 on: January 11, 2021, 11:56:49 AM »

You should pay attention to the following statements.

"The limiting factor to lengthening is the soft tissues. The risk of complications from lengthening increase dramatically with increased length. Up to 5 cm is a low-risk lengthening. Between 5 and 8 cm is medium risk. Over 8 cm is a high-risk lengthening. If a patient desires 10 cm or more of lengthening, it is much safer to lengthen the femur and the tibia each by 5 cm than to lengthen either bone by 10 cm."

He used to mean the same as meaning nowadays.And what's more,lengthening safe limit depends on each individual.If you can afford enough fund and time and good tolerance as well,you can even choose to do 16cm lengthening(His rebreak option).

Numbers cannot determine your final height but your body can.
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azr

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #2 on: January 11, 2021, 04:34:05 PM »

According to Paley's website. Doing 16cm by rebreaking (4 on both tibia and femur then 4 a year or so later) is the SAFEST way to get+16. What are your thoughts on that ? It sounds tempting despite the outrageous price
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HobbesTheDog

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #3 on: January 11, 2021, 07:14:30 PM »

Would have considered it if it didn't give you freak proportions.
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Height dysphoria since 2008. (age 5)
Hoping to undergo STRYDE 8cm femurs when I can afford it.
5'4 / 163.5 cm and likely still growing
Goal: 5'7.5 (171+) or taller, but hopefully 5'8 (173)

Kal el

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #4 on: January 11, 2021, 09:50:43 PM »

Well it may look freaky but if u get to a good height like above 180 or 185 then its ok.
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SpeedDialer

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #5 on: January 12, 2021, 12:47:14 AM »

ahhh I don't know what to make of all this :(

I thought Giotikas and Parihar recommended max 7cm on femur and max 6 cm on tibia? But Dr. Paley used to say 6.5 cm on tibia?

And I heard some forum members hit 8 cm for femur and seem to be happy with it and Dr. Giotikas did not stop them from going 8cm?
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FormerKidd

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #6 on: January 12, 2021, 06:59:35 AM »

How long until the current 8cm femur is safe limit drops as well?

Not likely to happen any time soon.
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Highest

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #7 on: January 12, 2021, 10:55:15 AM »

Not likely to happen any time soon.

Why do you think that is? You did 6.5cm what was your reasons for not pushing for the 8cm?
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FormerKidd

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #8 on: January 12, 2021, 04:10:24 PM »

Based on conversation with a patient (who did over 5cm on tibia) and one of the doctors when I was there.  8cm femur/5cm tibia is likely to be the max for a while.
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azr

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #9 on: January 12, 2021, 06:56:03 PM »

What if you split it tho ? 4cm first year then 4 cm next year ?
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ghkid2019

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #10 on: January 12, 2021, 07:18:53 PM »

What if you split it tho ? 4cm first year then 4 cm next year ?

One year Gap let's you stretch out everything with time and it'll be very doable so the concern at that point if you space two surgeries apart will shift to whether you are fine with the proportions provided by 8cm Tibias
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azr

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #11 on: January 12, 2021, 07:41:03 PM »

I am 160 cm so to only gain 8cm and be 168cm will NOT (In my opinion) be that much life changing. Thats why i m considering +16cm.. And the safest way will be to split it. 176cm seems reasonable Plus i ll be like the world approximate average.. I m really thinking this is the ONLY option for me
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Highest

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #12 on: January 13, 2021, 01:50:35 AM »

One year Gap let's you stretch out everything with time and it'll be very doable so the concern at that point if you space two surgeries apart will shift to whether you are fine with the proportions provided by 8cm Tibias

The whole 8cm tibias in two 4cm lengthenings needs to be explained way more. So over 5cm and it's a hard stop according to Paley yet 8cm split is ok. The soft tissues and tendons don't get naturally longer they are still stretched out just the same. What mechanism makes 8cm ok if split?
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FormerKidd

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #13 on: January 13, 2021, 03:44:51 AM »

The whole 8cm tibias in two 4cm lengthenings needs to be explained way more. So over 5cm and it's a hard stop according to Paley yet 8cm split is ok. The soft tissues and tendons don't get naturally longer they are still stretched out just the same. What mechanism makes 8cm ok if split?

You can also generally get more growth if you do femurs and tibias separately as opposed to together.  The reason is because often times the muscles struggle to grow enough and the break gives your muscles a chance to catch up.
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Medium Drink Of Water

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #14 on: January 13, 2021, 05:06:17 PM »

What mechanism makes 8cm ok if split?

None that I'm aware of.  Just do your 8 cm if you want 8 cm.
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Highest

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #15 on: January 13, 2021, 09:54:44 PM »

None that I'm aware of.  Just do your 8 cm if you want 8 cm.

Formerkidds point makes sense that doing 8cm split into 4cm each gives muscles a chance to recover but ultimately your ligaments and tendons don't get any longer they just stretch so your going to have the same issues on tibias anyway.

Does anyone know any diaries where anyone has done 8cm tibias with Paley split into 4cm lengthenings?
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FormerKidd

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #16 on: January 13, 2021, 10:43:28 PM »

Formerkidds point makes sense that doing 8cm split into 4cm each gives muscles a chance to recover but ultimately your ligaments and tendons don't get any longer they just stretch so your going to have the same issues on tibias anyway.

Paley (and I think most reputable doctors) will make you slow down or stop if the muscles get too tight.  I was told there are some risks of damage if things get too far out of wack, although I don't know the specifics.
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MakeMeTallAF

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #17 on: January 14, 2021, 03:20:17 AM »

Formerkidds point makes sense that doing 8cm split into 4cm each gives muscles a chance to recover but ultimately your ligaments and tendons don't get any longer they just stretch so your going to have the same issues on tibias anyway.

Does anyone know any diaries where anyone has done 8cm tibias with Paley split into 4cm lengthenings?

This is wrong! Look up distraction osteogenesis in limb lengthening. Yes your soft tissues do stretch, however they also grow due to the mechanical stretching force, similar to how your soft tissues get longer during your growth spurt in puberty.

The reason why its better to split 4 cm and 4 cm a year apart is so that the soft tissues have time to actually grow. Remember soft tissues don't grow as fast as bone, and a distraction rate of 0.5mm/day to 1mm/day is way too fast for your soft tissues to keep up. This can cause nerve damage or scarring/fibrosis.

Do your research before spreading misinformation please!
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Highest

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #18 on: January 14, 2021, 05:05:52 AM »

This is wrong! Look up distraction osteogenesis in limb lengthening. Yes your soft tissues do stretch, however they also grow due to the mechanical stretching force, similar to how your soft tissues get longer during your growth spurt in puberty.

The reason why its better to split 4 cm and 4 cm a year apart is so that the soft tissues have time to actually grow. Remember soft tissues don't grow as fast as bone, and a distraction rate of 0.5mm/day to 1mm/day is way too fast for your soft tissues to keep up. This can cause nerve damage or scarring/fibrosis.

Do your research before spreading misinformation please!

In all of cyborg4lifes interviews with Doctors from Paley to Lee they all said the bone can be lengthened much further than soft tissue due to limits with the tendons and ligaments having fixed amount of stretch in them. I can't find any information which shows that ligaments and tendons will grow and not stretch. Can you link any sources.
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MakeMeTallAF

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #19 on: January 14, 2021, 06:05:00 AM »

https://link.springer.com/chapter/10.1007/978-1-4471-0691-3_4

The soft tissues are the limiting factor because like I said they don't grow fast enough to keep up with the lengthening of .5 to 1mm/day. Paley himself has said the soft tissues grow as well.

"   Ilizarov in 1951 began developing his methods of “distraction osteogenesis”. He developed the process of new bone (termed regenerate) and soft tissue regeneration under the effect of slow and gradual distraction. Gradual traction on living tissue creates stresses that can stimulate and maintain the regeneration and active growth of certain tissue structures, termed the “law of tension stress” (Ilizarov, 1989; Paterson, 1990). "

Seriously look up distraction osteogenesis. It is the process being used in limb lengthening. Study up on it, and rewatch the Rozbruch and Paley interviews they mention it briefly too.
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ghkid2019

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #20 on: January 14, 2021, 06:44:22 AM »

In all of cyborg4lifes interviews with Doctors from Paley to Lee they all said the bone can be lengthened much further than soft tissue due to limits with the tendons and ligaments having fixed amount of stretch in them. I can't find any information which shows that ligaments and tendons will grow and not stretch. Can you link any sources.

I have literally watched both those interviews with Victor from cyborg from life and I am pretty sure they both mention the growth of brand new cells not just solely stretch
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Highest

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #21 on: January 14, 2021, 11:43:58 AM »

https://link.springer.com/chapter/10.1007/978-1-4471-0691-3_4

The soft tissues are the limiting factor because like I said they don't grow fast enough to keep up with the lengthening of .5 to 1mm/day. Paley himself has said the soft tissues grow as well.

"   Ilizarov in 1951 began developing his methods of “distraction osteogenesis”. He developed the process of new bone (termed regenerate) and soft tissue regeneration under the effect of slow and gradual distraction. Gradual traction on living tissue creates stresses that can stimulate and maintain the regeneration and active growth of certain tissue structures, termed the “law of tension stress” (Ilizarov, 1989; Paterson, 1990). "

Seriously look up distraction osteogenesis. It is the process being used in limb lengthening. Study up on it, and rewatch the Rozbruch and Paley interviews they mention it briefly too.

Thanks for the source. My understanding that the 0.75mm per day tibia and 1mm per day femurs was the speed which was meant to prevent preconsolidation. People then get contractures from the muscle being lengthened too fast at these speeds and creating scar tissue rather than regular tissue. If we could lengthen without the worry of preconsolidation the only concern would become remaining proportional as soft tissue issues are then removed. Is there something I'm missing here?
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MakeMeTallAF

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #22 on: January 15, 2021, 06:15:12 AM »

Thanks for the source. My understanding that the 0.75mm per day tibia and 1mm per day femurs was the speed which was meant to prevent preconsolidation. People then get contractures from the muscle being lengthened too fast at these speeds and creating scar tissue rather than regular tissue. If we could lengthen without the worry of preconsolidation the only concern would become remaining proportional as soft tissue issues are then removed. Is there something I'm missing here?

Yup this is exactly right from my understanding. The thing with LL is that it is just like how we grow during puberty (well except for the breaking your bones part), the main difference is that the distraction rate is way too fast for the soft tissues to actually keep up. If we could find a way to slow down the distraction rate while eliminating the risk of pre-consolidation, we would be able to get closer to 100% recovery and possibly even lengthen longer distances. I don't think there are any soft tissues that do not grow along with the bone, it's just that when they can't keep up they form scar tissue.

This could be a good question to ask to a doctor though, for anyone doing a consultation.
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Michael J. Assayag, MD

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #23 on: January 20, 2021, 12:39:39 AM »

Thanks for the source. My understanding that the 0.75mm per day tibia and 1mm per day femurs was the speed which was meant to prevent preconsolidation. People then get contractures from the muscle being lengthened too fast at these speeds and creating scar tissue rather than regular tissue. If we could lengthen without the worry of preconsolidation the only concern would become remaining proportional as soft tissue issues are then removed. Is there something I'm missing here?

Yes and no.


1mm per day comes from Dr. Ilizarov’s research  about the best yield in bone formation, But also that’s what the nerves and vessels will tolerate before stopping to work...

0.75mm/day in the tibia comes from the fact that the nerves are of smaller caliber and don’t tolerate stretching as much. The same way soft tissues don’t necessarily like to be stretched as much .

I am a limb lengthening surgeon a d that’s what I do every week. my advice is to be reasonable and to listen to your surgeon. Most surgeons have your best interest at heart. I know I do.
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Vibes

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Re: Dr Paley used to reccommend safe limit in tibias as 6.5cm
« Reply #24 on: January 20, 2021, 03:15:10 AM »

Speaking with Dr. Paley and Dr. Robbins, the limit was changed to 5cm because they consistently found too many people had big difficulties reaching 6.5cm.

In fact, speaking with recent patients who underwent quad surgery (surgery on both segments, 3 weeks apart)--most do not do 5cm femurs/5cm as is advertised by their combined plan. Most instead do 6cm femurs/4cm tibs because it's just plain hard to lengthen tibs compared to femurs.

I can't say for sure myself as I have not had surgery yet.
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