Efficacy and safety of limb lengthening in achondroplasia: A systematic review and meta-analysis

Abstract Purpose To systematically review the efficacy, safety, and outcomes of limb lengthening procedures in patients with achondroplasia, including effects on quality of life. Methods Following PRISMA guidelines, a systematic review and meta-analysis was performed. Eligible studies included patients with achondroplasia who underwent limb lengthening of the upper and/or lower extremities. Data were extracted on length gain, external fixator index, fixation duration, complications, and quality of life. Pooled means and 95% confidence intervals (CIs) were calculated using single-arm meta-analysis. Results Fourteen studies including 1149 patients were analyzed. The mean femoral gain was 8.85 cm (95% CI: 7.42–10.28), tibial gain 7.36 cm (95% CI: 6.21–8.52), and humeral gain 8.38 cm (95% CI: 7.01–9.74). The mean fixator index was 37.1 days/cm (95% CI: 32.37–41.82), with a mean fixation duration of 7.71 months (95% CI: 5.98–9.63). The overall complication rate was 56.1% (95% CI: 26.9–85.2). Importantly, the pooled quality of life score measured by the Paediatric Quality of Life Inventory was 75.69 (95% CI: 65.14–86.23), indicating moderate improvement despite high treatment burden. Conclusion Limb lengthening in achondroplasia achieves significant stature and proportional gains but requires prolonged treatment and carries a high complication risk. Nevertheless, improvements in functional ability and quality of life are evident, particularly when multi-limb lengthening is performed. Future studies should standardize outcome reporting, assess long-term QoL trajectories, and evaluate newer technologies such as intramedullary nails combined with multidisciplinary support.