Selective soft tissue release preserves growth plate architecture during limb lengthening

Although distraction osteogenesis has proven successful in children, concerns remain regarding potential growth inhibition of the lengthened limb. Twenty-one 8-week-old New Zealand White rabbits underwent a unilateral 40% tibial lengthening with the contralateral tibia as control. The animals were divided into Achilles tendon release and non-release groups. Radiographs and histomorphometric analysis of the proximal tibial growth plate was performed 5 and 10 weeks after distraction. The corrected length of tibias without tenotomy was significantly shorter than the contralateral controls, whereas those with tenotomy were statistically equivalent to the contralateral control tibias. Histologically, the operated limbs without tenotomy showed a significant decrease in thickness and loss of cellular architecture of the proximal tibial growth plate compared with the tenotomy groups, which were of near-normal appearance. A concomitant tendo Achilles lengthening performed with 40% tibial lengthening preserves proximal tibial growth plate architecture in this model.