Limb Lengthening Twice - Quadrilateral Lengthening

A really common question that comes up is getting leg lengthening surgery done more than once, specifically...twice!

And it’s understandable why. It’s really the only way you can maximize your height gain from the procedure without increasing the likelihood of short term complications that could occur if you did all length in one segment.

Now, not many people have done this, but I have stories of a few people who have and got some information to extrapolate from.

So I will address how it works, when to get them done if you’re considering two lengthenings and potential tradeoffs to expect.

Now comes the how: really there’s only one way to go about gaining max height which is to lengthen two segments of bone; the femurs in the thigh and the tibias in the lower leg. Most experienced LL surgeons don’t lengthen the femur over 8cm in length as that’s what most internal nails allow for and no more than 4-6cm in the tibia bone. So this means over the course of 2 lengthenings you could achieve a height of up to 14 cm or over 5 inches in height which is huge! But can you really...

You see, with great height comes great responsibilities. Such as added cost for both surgeries, longer recovery time, potential loss in ROM etc. etc.. I’ll explain...

But here comes another question that is really common: can I do both the tibias and femurs at the same time? And the reason why people ask this is they just want to get it over with all at once and that’s a fair point. And although the answer is technically yes it’s possible, it’s really not recommended by experienced LL surgeons for the main reason being... 

It increases chances that could jeopardize your health (things like embolisms become more common), it’s more painful being a bigger shock to the body and it could affect your resulting ROM because muscle takes way more time to adapt than bone takes to grow and heal. 

In fact, if you do both at the same time, you may actually not be able to get your desired lengthening goal. For example if you were going for 13cm you might only end up with 10cm before your muscle flexibility is tapped out and the doctor prevents any more.

So, the recommended way to go about this, based on information I’ve gathered, is doing the femurs first as you can get more length in one go, then a year or so later, you assess how you enjoy your new height, ROM, and everything else and then you could decide if you want to opt to get it done on the tibia bones.

Now there’s going to be people who don’t care and still want to not think about this a year later and want it to be behind them and want to get it done sooner. Well in that case the soonest recommended timeframe is a 3 week window between lengthening 1 and 2 to avoid complications. In this case you’ll do the tibias first because they heal slower and need a headstart and also this is to allow for full knee flexion.

I know a lot of people ponder the thought of doing both at the same time and it’s my advice you don’t be reckless and seek out a consultation with an experienced surgeon who would advise you properly in other words they shouldn’t do it at the same time.

Now what about those “trade-offs” that come with doing both regardless if you do them a month apart or a year apart if you go for the max length in both segments?

Well you gotta obviously expect to pay more for them both to get done. And you might have more of a challenge in getting full flexibility back but it can be done if you work hard enough. 

My advice is to start with one segment aka the femurs, wait a year and see if you really want to go for round 2. If so, make sure you spread them out by a year apart and don’t slack off on physiotherapy in between.