Chondromalacia Patella (Limb Length Discrepancy)

Causes

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Limb length discrepancies can result from:

• Congenital disorders of the bones, muscles or joints
• Disuse or overuse of the bones, muscles or joints caused by illness or disease
• Diseases, such as bone cancer
• Issues of the spine, shoulder or hip
• Traumatic injuries, such as severe fractures that damage growth plates

Symptoms

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The effects of limb length discrepancy vary from patient to patient, depending on the cause and size of the difference. Differences of 3.5 percent to 4 percent of the total length of the leg (about 4 cm or 1 2/3 inches in an average adult) may cause noticeable abnormalities when walking. These differences may require the patient to exert more effort to walk.

Diagnosis

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Limb length discrepancy can be measured during a physical examination and through X-rays. A limb length discrepancy may also be detected on a screening examination for curvature of the spine (e.g., scoliosis). However, limb length discrepancy does not cause scoliosis.

Treatment

Life’s too short to put up with pain.

Our experts are experienced in limb lengthening techniques, and they can explain the treatment options and decide what treatment, if any, is best for you. For minor limb length discrepancy in patients with no deformity, treatment may not be necessary. Because the risks may outweigh the benefits, surgical treatment to equalize leg lengths is usually not recommended if the difference is less than 1 inch. For these small differences, the physician may recommend a shoe lift, which can often improve walking and running, as well as relieve any back pain that may be caused by the limb length discrepancy. Shoe lifts are inexpensive and can be removed if they are not effective. In growing children, legs can be made equal or nearly equal in length with a relatively simple surgical procedure. This procedure slows down the growth of the longer leg at one or two growth sites. Your surgeon can tell you how much equalization can be gained by this procedure, which is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the limb length discrepancy will gradually decrease as the opposite extremity continues to grow and “catch up.”