Effect of tibial lengthening on the gastrocnemius muscle: A histopathologic and morphometric study in rabbits

Lee, Duk Yong; Choi, In Ho; Chung, Chin Youb; Chung, Phil Hyun; Geun, Je; Suh, Yeon Lim

doi:10.3109/17453679308994599

Cited by 59 publications

(37 citation statements)

References 9 publications

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“…Calandriello (1975) hypothesized that after tears occur in the muscle fibers, muscular regeneration proceeds with connective tissue repair at various levels. Lee et al (1993) partly supported this hypothesis with histological findings of both necrosis and fibrosis in a study on rabbits. On the other hand, Ilizarov (1989) suggested that muscle growth under the influence of tension-stress occurred without tears in the muscle fibers, not only by myofibrillogenesis in preexisting muscle fibers but also by new muscle formation.…”

Section: Discussionsupporting

confidence: 65%

Distraction frequency and the gastrocnemius muscle in tibial lengthening: Studies in rabbits

Mizumoto

Mizuta

Nakamura

et al. 1996

Acta Orthopaedica Scandinavica

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We compared the effect of various distraction frequencies on the gastrocnemius muscle by evaluating the histological findings, intramuscular enzyme contents, and DNA contents. In 15 rabbits, both tibiae were distracted 1 mm per day. The distraction frequency was 2 steps (0.5 mm/l2 hour) by hand on the right side and 120 steps (0.0083 m d l 2 minutes) by an auto-distractor on the left. The rabbits were divided into 3 subgroups based on length gain: lo%, 20%, and 30%. Histologically, there were no signs of fibrosis or edema and no differences in the number of necrotic cells, and intramuscular enzyme contents between the 2-and 120-step groups. The DNA content, however, was higher in the 120-step group

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Section: Discussionsupporting

confidence: 65%

Distraction frequency and the gastrocnemius muscle in tibial lengthening: Studies in rabbits

Mizumoto

Mizuta

Nakamura

et al. 1996

Acta Orthopaedica Scandinavica

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“…After long-term denervation, VEGF is still provable in muscles but significantly reduced [6]. Thus muscle atrophy at the distracted side might also be a factor responsible for the relatively high VEGF mRNA levels at the nondistracted side [13, 33,35].…”

Section: Discussionmentioning

confidence: 99%

Bilaterally increased VEGF‐levels in muscles during experimental unilateral callus distraction

Hansen-Algenstaedt

Algenstaedt

Böttcher

et al. 2003

Journal Orthopaedic Research

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Angiogenesis is essential for wound healing and proliferative processes such as bone formation and repair. Since increased expression of the vascular endothelial growth factor (VEGF) stimulates bone formation, it can be hypothesized that surgical procedures leading to a systemic increase of VEGF for instance during wound healing, influence enchondral ossification processes and might be responsible for observed growth phenomena during callus distraction. To study the mechanisms of angiogenesis in soft tissue during unilateral callus distraction, lengthening of the right tibia was performed in 12 beagles. After osteotomy, application of a ring fixator and after five latency days, distraction was started for 25 days. A control group of four additional beagles underwent no surgical procedure. Subsequent to the distraction period (Group A), muscle samples from six beagles were taken from the distracted side (ds) and the contralateral non-distracted side (n-ds), six beagles underwent an additional consolidation period of 25 days (Group B). Samples were analyzed for VEGF, VEGFR-1 and VEGFR-2 mRNA expression using real-time PCR and protein expression using Western Blot analysis. Muscles from both extremities showed significantly increased expression of VEGF and its cognate receptors VEGFR-112. Expression decreased significantly after the consolidation period, whereby the level at the nondistracted side decreased more than the level at the distracted side. Interestingly VEGF and VEGFR-I levels at the non-distracted side were significantly higher than at the distracted side. In contrast VEGFR-2, the receptor that mediates endothelial cell proliferation, showed higher levels at the distracted than at the non-distracted side. These findings indicate that callus distraction results not only in locally increased expression of VEGF and its receptors, but leads also to increased VEGF and VEGFR-112 levels at distant sides and might therefore be responsible for the observed growth phenomena during callus distraction.

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“…No wonder that the clinical challenges of muscle distraction and subsequent decrease of adjacent joint range of motion go in parallel with the amount of lengthening. This is reflected by histological changes after lengthening of more than 30 % of its original length [22,[116][117][118][119], as the whole muscle from origin to insertion is stretched [81]. The elastic limit of stretched muscles (strength-strain curve) is 10-15 % of the length at rest.…”

Section: Effects Of Bone Lengthening On Surrounding Tissuesmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

101

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Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

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Effect of tibial lengthening on the gastrocnemius muscle: A histopathologic and morphometric study in rabbits

Cited by 59 publications

References 9 publications

Distraction frequency and the gastrocnemius muscle in tibial lengthening: Studies in rabbits

Distraction frequency and the gastrocnemius muscle in tibial lengthening: Studies in rabbits

Bilaterally increased VEGF‐levels in muscles during experimental unilateral callus distraction

Current concepts of leg lengthening

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