Circumferential Periosteal Sleeve Resection: Results in Limb-Length Discrepancy Secondary to Poliomyelitis

Surgical Technique: Lower Limb-length Equalization by Periosteal Stripping and Periosteal Division

“…Clinically, several studies have reported a modest improvement of LLD by using various surgical techniques [4,11,25]. Jenkins et al [11] reported an improvement of approximately 1 cm after periosteal stripping alone.…”

“…Stimulating growth of the shorter limb before reaching skeletal maturation is one alternative [2,4,11,25] since it would not reduce height as would retarding growth of a Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.…”

“…Several nonoperative and operative approaches are used to correct LLD including shoe lifts [15], retarding growth of the longer leg (ie, epiphyseal stapling) [1] or epiphysiodesis [9], and increasing the length of the shorter leg (ie, periosteal stimulation procedure) [2,4,11,25] or distraction osteogenesis [5,13]. Shortening procedures reduce overall height [1,9] whereas lengthening procedures require extensive stretching with reported complications [16].…”

Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

“…However, the procedure of periosteal stripping (detaching the periosteum from the underlying bone without circumferentially cutting or removing the periosteum) has also been shown to accelerate physeal growth [1,9,10,13,25]. The two papers that demonstrate the most consistent and promising clinical results combined both circumferential periosteal transection with periosteal stripping or resection [7,15]. Thus, knowing which of these procedures will yield the most growth with the least morbidity is unknown and has likely contributed to their lack of clinical use.…”

CORR Insights®: Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

“…Furthermore, clinical investigators have implicated the torn (''untethered'') periosteum as a contributor to limb overgrowth following a pediatric femoral shaft fracture and asymmetric medial physeal growth leading to genu valgum after certain proximal tibial fractures in young children [2,3,9]. Although studies have shown that leglength discrepancy can be addressed by transecting or stripping the periosteum of the shorter limb in young patients [4,6,8,10], I believe that few surgeons currently apply these principles in clinical practice. Perhaps due to the reported unpredictability [10] and the lack of robust basic-science support, this seemingly straightforward method of growth stimulation of the short leg has not gained the popularity enjoyed by surgical alternatives, such as gradual lengthening or a contralateral epiphysiodesis.…”