Timing of physiodesis in limb length inequality. The Straight Line Graph applied in 30 patients

In a prospective study 30 children underwent 33 physiodeses for lower limb length inequality (LLI). Timing of surgery was based on (bi)annual orthoradiographic measurements and skeletal age, and in accordance with Moseley's Straight Line Graph. The mean predicted LLI was 5.2 (3.0-11) cm and the mean LLI at the end of growth was 1.4 (0.0-4.3) cm. In 9 patients final LLI exceeded 1.5 cm, and one of these patients was operated on twice. In total, secondary operations were performed three times. After analysis of the failures it is concluded that the accuracy of the Straight Line Graph is mainly limited by the pattern of skeletal maturation. Recommendations to prevent failures from other causes are given.