title: Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Rare Diseases and Department of Orthopaedic Surgery, Seoul, Korea.
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Song
authors.forename: Mandar Vikas
authors.initials: MV
authors.lastname: Agashe
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Huh
authors.forename: Soon-Young
authors.initials: SY
authors.lastname: Hwang
authors.forename: Hae-Ryong
authors.initials: HR
authors.lastname: Song
mesh_terms: D000130:Achondroplasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D019857:Osteogenesis, Distraction / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery