{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:50Z","timestamp":1787755550548,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recently, limb lengthening devices have shifted from external fixators to telescoping magnetic intramedullary lengthening nails (MILNs), which lengthen strictly along the bone's anatomic axis. Baumgart proposed the reverse planning method, overcorrecting lateral shift with a distal osteotomy and slight varus angulation. The untested assumption that antegrade lengthening along the anatomic axis causes lateral mechanical axis deviation (MAD) prompted our study, which examines MILNs' effect on lower limb alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively evaluated records for 154 femoral antegrade MILNs inserted in 122 adult patients for limb lengthening. We excluded patients who underwent concomitant corrective osteotomies or tibial lengthening, or who had malunion, nonunion, mechanical failure, or revision surgery for any reason. Long-leg standing radiographs were taken preoperatively, at the end of lengthening, around 3 months postoperatively, and at the culmination of consolidation (approximately 6 months postoperatively). MAD and anatomic mechanical angle (AMA) were assessed as primary outcomes at each radiographic time point for sequential comparison. The predicted MAD was derived from the trigonometric formula (Predicted MAD = lengthening \u00d7 sin [AMA]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Average preoperative MAD was 2.4 mm medial (SD = 10.6), diminishing to 1.9 mm medial (SD = 13.2) by the end of lengthening. On assessment at consolidation, average MAD had equilibrated back to 2.6 mm medial. Our results showed a net shift of 0.18 mm, whereas the predicted shift was 5.4 mm. The mean preoperative AMA was 5.9 mm (SD = 1.49). At the end of lengthening, the average AMA had decreased to 4.8 mm (SD = 1.4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our data indicated minimal to no impact on the mechanical axis or joint alignment of the lower limb after antegrade lengthening using a telescoping femoral MILN in a deformity-free femur. Study results suggested that the femur typically realigned in a way that minimized mechanical deviation while preserving joint alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.24.00168","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T14:00:28Z","timestamp":1744639228000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Mechanical Axis Deviation Shift in Limb Lengthening Over the Anatomical Axis, a Retrospective Analysis"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9917-2974","authenticated-orcid":false,"given":"Akram","family":"Al Ramlawi","sequence":"first","affiliation":[{"name":"International Center for Limb lengthening, Sinai of Baltimore, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-7622","authenticated-orcid":false,"given":"Philip K.","family":"McClure","sequence":"additional","affiliation":[{"name":"International Center for Limb lengthening, Sinai of Baltimore, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-9251","authenticated-orcid":false,"given":"John E.","family":"Herzenberg","sequence":"additional","affiliation":[{"name":"International Center for Limb lengthening, Sinai of Baltimore, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-2997","authenticated-orcid":false,"given":"Michael","family":"Assayag","sequence":"additional","affiliation":[{"name":"International Center for Limb lengthening, Sinai of Baltimore, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4]]},"reference":[{"issue":"1","key":"R1-20250424","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s10195-019-0541-3","article-title":"Limb lengthening history, evolution, complications and current concepts","volume":"21","author":"Hosny","year":"2020","journal-title":"J Orthop Traumatol"},{"issue":"4","key":"R2-20250424","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1097\/CORR.0000000000002036","article-title":"What are the potential benefits and risks of using magnetically driven antegrade intramedullary lengthening nails for femoral lengthening to treat leg length discrepancy?","volume":"480","author":"Frommer","year":"2022","journal-title":"Clin Orthop Relat Res"},{"issue":"9","key":"R3-20250424","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1080\/17434440.2017.1367284","article-title":"The use of flexible intramedullary nails in limb lengthening","volume":"14","author":"Popkov","year":"2017","journal-title":"Expert Rev Med Devices"},{"issue":"2","key":"R4-20250424","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.otsr.2015.10.011","article-title":"Bone lengthening using the Fitbone motorized intramedullary nail: the first experience in France","volume":"102","author":"Accadbled","year":"2016","journal-title":"Orthop Traumatol Surg Res OTSR"},{"issue":"3","key":"R6-20250424","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1586\/17434440.2015.1005604","article-title":"PRECICE intramedullary limb lengthening system","volume":"12","author":"Paley","year":"2015","journal-title":"Expert Rev Med Devices"},{"issue":"5","key":"R7-20250424","doi-asserted-by":"crossref","first-page":"431","DOI":"10.5312\/wjo.v8.i5.431","article-title":"Effect of lengthening along the anatomical axis of the femur and its clinical impact","volume":"8","author":"Emara","year":"2017","journal-title":"World J Orthop"},{"issue":"2","key":"R8-20250424","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00064-009-1709-4","article-title":"The reverse planning method for lengthening of the lower limb using a straight intramedullary nail with or without deformity correction. A new method","volume":"21","author":"Baumgart","year":"2009","journal-title":"Oper Orthop Traumatol"},{"issue":"2","key":"R9-20250424","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5005\/jp-journals-10080-1425","article-title":"Bone Ninja mobile app for reverse planning method in internal limb deformity and lengthening surgery","volume":"14","author":"Hung","year":"2019","journal-title":"Strateg Trauma Limb Reconstr"},{"issue":"2","key":"R10-20250424","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s11751-018-0312-3","article-title":"The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method)","volume":"13","author":"Galal","year":"2018","journal-title":"Strateg Trauma Limb Reconstr"},{"key":"R11-20250424","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/00003086-199710000-00023","article-title":"A fully implantable motorized intramedullary nail for limb lengthening and bone transport","volume":"343","author":"Baumgart","year":"1997","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"R12-20250424","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.2106\/00004623-199710000-00003","article-title":"Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening","volume":"79","author":"Paley","year":"1997","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"R13-20250424","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1302\/0301-620X.94B9.28672","article-title":"The effect on mechanical axis deviation of femoral lengthening with an intramedullary telescopic nail","volume":"94","author":"Burghardt","year":"2012","journal-title":"J Bone Joint Surg Br"},{"key":"R14-20250424","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jor.2024.05.018","article-title":"PRECICE nail bending in femur lengthening","volume":"56","author":"Al Ramlawi","year":"2024","journal-title":"J Orthop"}],"updated-by":[{"DOI":"10.2106\/jbjs.oa.er.24.00168","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000}}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.24.00168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:05Z","timestamp":1787751845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.24.00168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.24.00168","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}