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The Journal of Bone and Joint Surgery 82:1432 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Multiplier Method for Predicting Limb-Length Discrepancy*

Dror Paley, M.D., F.R.C.S.(C){dagger}, Anil Bhave, P.T.{dagger}, John E. Herzenberg, M.D., F.R.C.S.(C){dagger} and J. Richard Bowen, M.D{ddagger}

Investigation performed at the Maryland Center for Limb Lengthening and Reconstruction, Baltimore, Maryland
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Maryland Center for Limb Lengthening and Reconstruction, The James Lawrence Kernan Hospital, 2200 Kernan Drive, Baltimore, Maryland 21207. E-mail address for D. Paley: drorpaley@ hotmail.com. E-mail address for A. Bhave: anilbhave{at}yahoo.com E-mail address for J. E. Herzenberg: frscs@aol.com.
{ddagger}The Alfred I. duPont Institute, 1600 Rockland Road, Wilmington, Delaware 19899. E-mail address: jrbowen@nemours.org.

Background: In patients with a congenital or developmental limb-length discrepancy, the short limb grows at a rate proportional to that of the normal, long limb. This is the basis of predicting limb-length discrepancy with existing methods, which are complicated and require multiple data points. The purpose of our study was to derive a simple arithmetic formula that can easily and accurately predict limb-length discrepancy at skeletal maturity.

Methods: Using available databases, we divided the femoral and tibial lengths at skeletal maturity by the femoral and tibial lengths at each age for each percentile group. The resultant number was called the multiplier. Using the multiplier, we derived formulae to predict the limb-length discrepancy and the amount of growth remaining. We verified the accuracy of these formulae by evaluating two groups of patients with congenital shortening who were managed with epiphysiodesis or limb-lengthening. We also calculated and compared the multipliers for other databases according to radiographic, clinical, and anthropological lower-limb measurements.

Results: The multipliers for the femur and tibia were equivalent in all percentile groups, varying only by age and gender. Because congenital limb-length discrepancy increases at a rate proportional to growth, the discrepancy at maturity can be calculated as the current discrepancy times the multiplier for the current age and the gender. This calculation can be performed with use of a single measurement of limb-length discrepancy. For progressive developmental (noncongenital) discrepancies, the discrepancy at skeletal maturity can be calculated as the current discrepancy plus the growth inhibition times the amount of growth remaining. The timing of the epiphysiodesis can also be calculated with the multiplier. The predictions made with use of the multiplier method correlated well with those made with use of the Moseley method as well as with the actual limb-length discrepancy in both the limb-lengthening and epiphysiodesis groups. The multipliers derived from the radiographic, clinical, and anthropological measurements of femora and tibiae were all similar to each other despite differences in race, ethnicity, and generation.

Conclusions: The multiplier method allows for a quick calculation of the predicted limb-length discrepancy at skeletal maturity, without the need to plot graphs, and is based on as few as one or two measurements. This method is independent of percentile groups and is the same for the prediction of femoral, tibial, and total-limb lengths. The multiplier values are also independent of generation, height, socioeconomic class, ethnicity, and race. We verified the accuracy of this method clinically by evaluating patients who had been managed with limb-lengthening or epiphysiodesis. The method was also comparable with or more accurate than the Moseley method of limb-length prediction.


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