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Retrograde Intramedullary Femoral Lengthening With Acute Deformity Correction in
Children, Adolescents, and Young Adults
#MMPMID41220603
Dahl MT
; Wellings EP
; Funk C
; Georgiadis AG
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41220603
show ga
BACKGROUND: Acquired and congenital limb length discrepancies often coexist with
deformities of the distal femur. Lengthening of the femur along its anatomic axis
changes the limb's mechanical alignment. Angular correction and lengthening can
be achieved at the same site if a retrograde lengthening nail is used with a
specific preoperative planning method ("reverse planning") which permits
patient-specific selection of the final mechanical axis. METHODS: A consecutive
cohort series of children, adolescents, and young adults (mean 15.6 ± 4.8 years)
undergoing retrograde implantable femoral lengthening between the years 2011 and
2024 were analyzed. Surgical details, lengthening parameters, Limb Lengthening
and Reconstruction Society (LLRS)-AIM index, accuracy of final correction, and
complications were reviewed and classified. Patients were eligible only if the
distal femoral physis was closed. RESULTS: Seventy-three lengthening were
eligible in the study period. Average lengthening was 4.2 ± 1.4 cm (range 2.0-8.0
cm), and consolidation index was 39.4 ± 21.9 days/cm. Deformities and length
discrepancies were moderately complex, with a mean LLRS AIM score of 6 (range
1-13). Complication rates were similar to previous reports of intramedullary
femoral lengthening, comparable between congenital (12 of 31, 39%) and acquired
etiologies (16 of 42, 38%). Preoperative coronal alignment ranged from 14° varus
to 20° valgus, while final coronal alignment was 0.4° ± 3.4° of neutral (range 7°
valgus to 13° varus). Coronal deformities up to 20° and sagittal deformities up
to 23° were corrected acutely at the lengthening site. CONCLUSIONS: Retrograde
intramedullary femoral lengthening with acute deformity correction at the same
site is an alternative to antegrade lengthening with separate osteotomy of the
distal femur in children and adolescents. The reverse planning method allows
reproducible length and deformity correction at the same location. Specific
intraoperative technical adjuncts are used to achieve and maintain the desired
alignment. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors
for a complete description of levels of evidence.
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