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Leg Length Discrepancy/ Leg Length Difference
Dong Hoon Lee
Leg Length Discrepancy (LLD) is defined as a condition in which the paired lower extremity limbs have a noticeably unequal length.
If a person’s leg lengths are significantly different, either the pelvis is tilted in the standing position, or the person has to bend one knee in order to feel comfortable. In severe cases, limping and compensatory scoliosis may occur. Compensatory scoliosis is a spinal curve in the standing position which disappears when the patient sits. In the long term, LLD can cause arthritis in the back, hip joints, and knees.
Correction of leg length discrepancy and ankle deformity
Leg length discrepancy- tibial lengthening using PRECICE nail
Leg length discrepancy- tibial lengthening using LON
Compensatory scoliosis is a spinal curve in the standing position which occur when patient’s pelvis is tilted because of LLD.
Diagnosis of LLD (Leg Length Discrepancy)
Our body is not completely symmetrical; arm lengths and leg lengths are different. Medically, treatment is required for differences greater than 2-2.5cm. However, sometimes patients with less than 2cm LLD express discomfort. Treatment must be assessed on an individual basis, rather than textbook standards. Frequently, patients are mistaken about their leg lengths. Thus, to diagnose LLD, accurate measurement is important.
What are the causes of LLD?
In many cases there is no specific cause. The most common cause is idiopathic hemihypertrophy, which occurs without reason. In this case, patients are diagnosed at a young age and the difference becomes larger as they grow. If a patient’s leg was fractured or they had surgery on one leg during childhood, that leg tends to grow more compared to the other leg. Also, if a femoral head is not developed normally because of LCP (Legg Calve Perthes) disease, it results in different leg lengths. In addition to that, congenital leg deformities such as congenital limb deficiency and congenital pseudoarthrosis tibia are possible causes of LLD.
How is LLD treated?
Mainly, there are two options. One is ‘lengthening’ the shorter limb by using shoe inserts or undergoing limb lengthening surgery. The other way is shortening. Patients with open growth plates can delay growth of the longer leg by holding the growth plate for a while. Adults can also have shortening surgery, but this surgery is quite complicated compared to the one holding the growth plate.
Lengthening a Short Femur
Lengthening a Short Tibia (Lengthening Over Nail)
Lengthening a Short Femur – PRECICE
Lengthening a Short Tibia, with Knock Knees and Rotational Deformity Correction – PRECICE
Lengthening a short tibia, with Knock Knees and Flexion Deformity Correction – LON
LLD and Deformity after Trauma
Epiphysiodesis – LLD (Shortening) and Knock-knees Correction
Epiphysiodesis – LLD (Shortening)
What considerations should be made in treatment of LLD?
Theoretically, discrepancies smaller than 2-2.5cm do not need treatment. LLD patients with discrepancies larger than 2-2.5cm consider shoe inserts or surgical methods. During consultation, the true length difference shown on the x-ray, and also the patient’s perception about the difference, are discussed. Sometimes the true difference and the patient’s perception of the difference are not aligned. There are many treatment methods to choose from, such as shoe inserts, lengthening surgery, epiphysiodesis and shortening. Every decision is made on an individual basis.
Simultaneous correction of leg length discrepancy and bowleg
Congenital hemihypertrophy – leg length discrepancy- treated by Ilizarov lengthening
Fibular hemimelia – leg length discrepancy- treated by LON
leg length discrepancy- treated by femoral lengthening(LON)
leg length discrepancy and coxa vara deformity- treated by femoral lengthening(LOP) and correctional osteotomy
leg length discrepancy, bow leg, and genu recurvatum deformity- treated by tibial lengthening(LON) and correctional osteotomy
Leg Length Discrepancy and Knock-knee – treated by Tibia Lengthening and Deformity Correction simultaneously
Leg Length Discrepancy knee joint line Deformity
Simultaneous treatment of Leg Length Discrepancy and Knock-knee
Limb lengthening surgery technique has advanced rapidly (especially, ‘lengthening with internal nail’). It decreases complication rates significantly compared to conventional external fixator lengthening (Ilizarov).
Limb lengthening surgery techniques have advanced rapidly. In particular, ‘lengthening with an internal nail (PRECICE)’ has been a game changer, decreasing complication rates significantly compared to conventional external fixator lengthening (with Ilizarov).
Donhoon Advanced Limb Lengthening Reconstruction Institute is a World leader in Leg Length Discrepancy treatment.
Leg Length Discrepancy Treatment – Lengthening with PRECICE
Pediatric Leg Length Discrepancy – Epiphysiodesis X-ray
Child LLD is more complicated than in adults. Doctors must predict the final leg length difference because it is likely to change as a child grows. However, there is some advantage.
Adults need to undergo relatively big operations (bone must be partially cut out) to shorten, but children’s growth plates may be held with tiny screws (Epiphysiodesis).
Recovery is fast (1-2days), scarring is minimal (1cm) and they can go back to school almost right after the surgery.
One important consideration in child LLD treatment is ‘height’. If we decide to have epiphysiodesis because of its advantages, children’s muscles could become stressed from short height or short legs when growth is complete.
Therefore, limb lengthening can be a good option if the child’s expected height is short. However, lengthening surgery is a long and tough procedure.
All of these factors should be considered for the child.
pediatric leg length discrepancy
Congenital hemihypertrophy- leg length discrepancy and knock knee- treated by epiphysiodesis screw
Pediatric Leg Length Discrepancy treated by Illizarov lengthening
Congenital hemihypertrophy- leg length discrepancy- treated by lengthening of leg
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