Introduction: Treatment options in patients with extreme tall stature are limited. Bilateral epiphysiodesis has emerged as a possible treatment method aiming to reduce final height. However, there is still insufficient data on long-term safety and final height outcome. Therefore, the aim of this study was to assess the efficacy and safety of bilateral epiphysiodesis to reduce final adult height in tall adolescents. Methods: The study population consisted of 72 patients with extreme tall stature who were followed at the Pediatric Endocrine Clinic at the Karolinska University Hospital, Stockholm (Sweden), and subsequently underwent bilateral epiphysiodesis around the knees (girls n = 45, boys n = 27). Results: When compared to the final height prediction at time of surgery, the procedure significantly reduced the achieved final height by a mean of 3.6 cm ± 0.4 cm in girls (p < 0.001; 26.0 ± 2.9% reduction) and 8.6 ± 0.9 cm in boys (p < 0.001; 40.5 ± 3.0% reduction). Furthermore, a negative correlation was observed between the absolute height reduction and the bone age at time of surgery, which was stronger in boys (r = −0.63, p < 0.001) than in girls (r = −0.44, p < 0.001). Besides reducing final height, body proportions were affected in all patients subjected to bilateral epiphysiodesis. However, as tall individuals typically have relatively long legs, body proportions were rather normalized after the surgery. There were no serious complications reported. Conclusion: This study suggests that bilateral epiphysiodesis is an efficient and safe method to reduce final height in extremely tall adolescent girls and boys. The achieved height reduction was higher in boys and when performed at an earlier bone age. Importantly, no serious side effects were reported. However, a continued follow-up is still warranted to detect any potential rare complications.

Tall stature, defined as a height above 2 standard deviation score from the mean, is mostly caused by genetic factors (constitutional tall stature) and is, mainly in Northern Europe, a common reason for consulting a pediatric endocrinologist [1]. However, an underlying condition should always be considered/ruled out in patients with tall stature as they may require medical attention or treatment. Examples of an underlying condition could be homocystinuria, growth hormone and thyroid hormone excess, obesity, and syndromes such as Beckwith-Wiedemann, Marfan, Klinefelter, Weaver, and Sotos syndrome [2, 3]. In Sweden, extreme tall stature is defined as final height (FH) of >200 cm in males and >185 cm in females, corresponding to approximately 3 standard deviation score above the mean [4‒7].

Tall stature is generally not considered a severe somatic problem, although back problems, scoliosis, and kyphosis may occur. In addition to orthopedic problems, a higher incidence of psychological problems has been observed, such as social anxiety, withdrawing socially, and less assertiveness (7–11). In addition, tall stature is associated with practical problems such as finding appropriate bedding, shoes, and clothing [8‒12]. On the other hand, taller individuals are prone to have a more positive personality with higher self-esteem, intelligence, and ambition [13‒15].

When consulting a pediatric endocrinologist, tall adolescents and/or their caregivers often express a strong desire to limit further growth. However, treatment options are limited. In the past, hormonal treatment with high-dose estradiol in girls and high-dose testosterone in boys was used to reduce FH. However, its use has decreased dramatically due to long-term complications and side effects [16, 17]. In boys, known side effects of high-dose testosterone treatment include acne, weight gain, gynecomastia, behavioral changes, muscle ache, and aggressiveness [11, 18, 19]. In girls, known side effects of high-dose estradiol treatment include headache, nausea, calf cramps, and weight gain [11, 20, 21]. More serious complications include changes in coagulation parameters [22] as well as decreased fertility [17] and possibly an increased risk of breast cancer occurrence [17, 20, 23]. In addition to high-dose sex hormone treatment, the somatostatin analog octreotide has been used to decrease FH in tall-stature patients. Although showing promising short-term results [24, 25], long-term treatment does not seem to decrease FH enough to justify the treatment [26]. However, larger studies assessing the safety and efficacy of octreotide treatment in tall-stature patients are lacking.

As an alternative treatment option, bilateral epiphysiodesis around the knee may be performed to effectively reduce adult height in extremely tall girls and boys [27‒29]. Since many years, unilateral epiphysiodesis has been applied in patients with angular deformities or leg length difference where the treatment has been found to be effective and safe with only rare complications reported [30, 31]. In contrast, when epiphysiodesis is performed bilaterally in extremely tall adolescents, only limited efficacy and safety data are available. In two studies of tall adolescents from the Netherlands (n = 77 and n = 17), bilateral percutaneous epiphysiodesis surgery was reported to be safe with mean FH reductions of 7.0 cm in boys and 5.9 cm in girls [28, 29]. In a cohort of 21 tall adolescents undergoing bilateral epiphysiodesis, we earlier reported a similar height reduction in boys (6.4 cm), while the effect was slight less in girls (4.1 cm), and no serious complications were identified [27].

Even though available outcome data are so far promising, the efficacy and safety of bilateral epiphysiodesis need to be verified in larger cohorts justifying its continued use as the treatment is still controversial, especially when performed in healthy adolescents. To address this, we here provide follow-up data in a large cohort of tall adolescents subjected to bilateral epiphysiodesis in our national referral center.

Study Population

The study population included 72 patients who were followed at the Pediatric Endocrine Clinic at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm (Sweden), between 1997 and 2015 and who were subjected to bilateral epiphysiodesis. The study was approved by the Local Ethical Committee. Tall boys and girls who met all inclusion criteria were offered surgical treatment. Inclusion criteria were (1) FH prediction of ≥185 cm in girls and ≥200 cm in boys, (2) predicted remaining growth of ≥8 cm, (3) a relative sitting height below the mean for the respective age, and (4) a strong patient and family desire to undergo treatment. Written informed consents were obtained before the procedure from the patients as well as their legal guardians. Only patients who had reached FH were included in this report. Twenty-one patients from our previous publication [27] and 51 new patients were included in the present report.

Outcome Measures

Bilateral epiphysiodesis operation was performed as previously described [27]. In brief, a tourniquet was first applied to the leg to reduce bleeding. An X-ray image intensifier (C-arm) was used to identify the growth plates of the proximal tibia, fibula, and the distal femur. Two 5 mm skin incisions were made on the lateral side of the distal femur and the proximal tibia. The removal of the growth plates of the femur and the tibia were performed using a drill (8 mm) and several oval straight and angulated sharp curettes (5–7 mm). The growth plate of the fibula was addressed from anterior, using the tibial incision in order to prevent damage to the peroneal nerve. A 3 mm sharp oval curette was used in the fibula. The curettage was guided and controlled by regular snapshots with the image intensifier. The aim was to remove 25–50% of the growth plate in order to induce bony bridge formation across the physis and thereby limit further growth. To prevent extraosseous bone formation, special attention was paid to the subcutaneous removal of all the curetted tissue. Lastly, local anesthesthetics were injected abundantly in the curetted bone canals and adjacent to the intracutaneously closed skin incisions. The whole procedure lasted for approximately 30–40 min per leg.

Almost all of the surgeries were performed by the same experienced surgeon (experience >25 years). At each time patients presented to the clinic, height and sitting height were measured by an experienced professional using a Harpenden stadiometer. Bone age assessment was determined by two blinded experts on X-rays of the left hand using the atlas of Greulich and Pyle [32], and their mean value was taken. If the bone age ratings between these two readers diverged >0.5 years, bone age ratings were reassessed by both and discussed thereafter. FH predictions were calculated using the Bayley-Pinneau tables [33].

Follow-Up of Patients

Between 9 and 12 months after the surgery, knee X-rays of both legs were performed to confirm total destruction of the growth plates after being subjected to epiphysiodesis. Patients presented to the clinic every 12 months thereafter until FH was reached. At each visit, total height and sitting height were measured, and the patients’ wellbeing assessed. FH was defined as an annualized height velocity less than 0.5 cm/year when growth had been monitored over a minimum of 6 months. When reaching FH, X-rays of both legs were performed to measure the hip-knee-ankle (HKA) angles to rule out any angulation. The HKA angle is a measure of the angulation between the mechanical axes of the femur and tibia and is evaluated by performing a full-length X-ray of the lower extremity. Therefore, it allows a quantification of the degree of any valgus or varus deformity [34]. The HKA angles at FH were then compared to the X-ray measurements before the procedure. In addition to radiological measurements, leg lengths were calculated subtracting the sitting height from the measured total height and compared to measurements preoperatively. Furthermore, the patients were assessed clinically focusing on the safety and efficacy of the procedure.

Statistics

Results are reported as mean ± standard error of mean. Student’s t test was applied to detect any differences between two groups. When normality test failed, Wilcoxon signed rank test was used. To assess the relationship between pairs of variables, Pearson’s correlation was used. A p value <0.05 was considered significant.

Baseline Characteristics

In Table 1, baseline characteristics are listed according to the sex of the patients. Patients had mostly been diagnosed with constitutional tall stature except for six patients with Marfan syndrome and three with Klinefelter syndrome. By average, girls were younger when undergoing bilateral epiphysiodesis (p < 0.001 vs. boys), and their mean bone age was less advanced at the time of the surgery (p < 0.001). Furthermore, the remaining predicted growth was higher in boys (20 cm) than in girls (13.2 cm; p < 0.001). At the time of surgery, most patients were mid-pubertal (Tanner B2–B5 for girls and G2–G5 for boys), and the boys were slightly more advanced in their pubertal development (p = 0.03).

Table 1.

Baseline characteristics and outcome of epiphysiodesis in girls and boys

CA at surgery, yearsBA at surgery, yearsHeight at surgery, cmPFH at surgery, cmFH, cmPFH-FH, cmHeight red., %
Girls (n = 45) 12.3±0.2 12.1±0.1 175.7±0.6 188.9±0.5 185.3±0.5* 3.6±0.4 26.0±2.9 
Boys (n = 27) 13.7±0.2 13.6±0.1 188.4±1.1 208.4±0.9 199.9±0.9* 8.6±0.9 40.5±3.0 
CA at surgery, yearsBA at surgery, yearsHeight at surgery, cmPFH at surgery, cmFH, cmPFH-FH, cmHeight red., %
Girls (n = 45) 12.3±0.2 12.1±0.1 175.7±0.6 188.9±0.5 185.3±0.5* 3.6±0.4 26.0±2.9 
Boys (n = 27) 13.7±0.2 13.6±0.1 188.4±1.1 208.4±0.9 199.9±0.9* 8.6±0.9 40.5±3.0 

Data are presented as mean ± standard error of mean.

Statistics applied as detailed in Methods section.

Chronological age (CA), bone age (BA), predicted final height (PFH) at time of surgery (bilateral epiphysiodesis); final height (FH) and height reduction (height red.).

*p < 0.001 versus PFH at time of surgery.

Efficacy of Bilateral Epiphysiodesis

When the predicted final height was compared to the achieved FH, it was significantly reduced in both girls and boys treated with bilateral epiphysiodesis surgery (p < 0.001 for both sexes; Table 1). The mean achieved FH was 185.3 ± 0.5 cm in girls and 199.9 ± 0.9 cm in boys, and the mean reduction of FH in patients subjected to the surgery was 3.6 cm ± 0.4 cm in girls and 8.6 ± 0.9 cm in boys.

In boys, final adult height was reduced by between 3.9 and 22.6 cm, except for two patients where adult height was only reduced by 0.3 and 0.4 cm, respectively. In the first of these two patients (0.3 cm FH reduction), the upper body growth was 9.0 cm, whereas leg growth was only 0.9 cm. In the second patient, the upper body increased by 6.5 cm, while leg growth was only 1.5 cm. Both these patients had an already advanced bone age at the time of surgery (14.5 years in patient one and 14.2 years in patient two). In girls, the FH reduction ranged between 1.0 and 10.0 cm, except for 3 patients (FH reduction −0.5, 0.0, 0.1 cm, respectively). In these 3 patients (bone age ranged between 11.4 and 13.3 years), leg growth was only between 0.1 and 0.8 cm, while the upper body segment growth ranged between 5.5 and 11.1 cm, suggesting that the procedure was indeed effective and that the Bayley-Pinneau method underestimated the remaining growth potential in these patients. When looking at the growth after surgery, it is not surprising that most of the growth occurred in the upper body segment (Fig. 1): mean increase in sitting height was in girls 8.0 ± 0.5 cm and in boys 8.6 ± 0.8 cm, while mean leg growth (increase in total height minus increase in sitting height) was 0.2 ± 0.4 cm in girls versus 2.3 ± 0.8 cm in boys.

Fig. 1.

Predicted remaining growth (cm) at time of epiphysiodesis surgery and observed increases in height (cm), sitting height (cm), and leg length (cm) from time of surgery until FH was reached. Data are presented as mean ± standard error of mean for all patients and also separately for girls and boys.

Fig. 1.

Predicted remaining growth (cm) at time of epiphysiodesis surgery and observed increases in height (cm), sitting height (cm), and leg length (cm) from time of surgery until FH was reached. Data are presented as mean ± standard error of mean for all patients and also separately for girls and boys.

Close modal

Concerning the timepoint of surgery versus height reduction, a negative correlation between the bone age at time of surgery and the achieved height reduction was observed (Fig. 2). This association was stronger in boys (r = −0.63, p < 0.001) than in girls (r = −0.44, p < 0.001).

Fig. 2.

Negative correlation between bone age at the time of surgery and height reduction (vs. predicted growth) after bilateral epiphysiodesis as shown for girls (r = −0.44, p < 0.001) (a) and boys (r = −0.63, p < 0.001) (b).

Fig. 2.

Negative correlation between bone age at the time of surgery and height reduction (vs. predicted growth) after bilateral epiphysiodesis as shown for girls (r = −0.44, p < 0.001) (a) and boys (r = −0.63, p < 0.001) (b).

Close modal

Effect on Body Proportions

Prior to surgery, all girls and boys showed a relative sitting height below the mean for the respective age indicating relatively long legs in relation to their upper body segment (Fig. 3). At FH, an increase in relative sitting height was observed in both sexes (p < 0.001 vs. sitting height before surgery). The mean relative sitting height at FH was in treated boys 52.2 ± 0.2% (n = 25) and girls 52.4 ± 0.1% (n = 42) which is not very different from the reference relative sitting height (51.5% in boys and 52.4% in girls) according to Tanner et al. [35].

Fig. 3.

Relative sitting height (%) in girls (a) and boys (b) at time of bilateral epiphysiodesis surgery and at FH. Each dot and corresponding line represent one patient. n = 39–42 (girls) and n = 22–25 (boys).

Fig. 3.

Relative sitting height (%) in girls (a) and boys (b) at time of bilateral epiphysiodesis surgery and at FH. Each dot and corresponding line represent one patient. n = 39–42 (girls) and n = 22–25 (boys).

Close modal

Safety of the Procedure

There were no serious complications reported in our study (Table 2). About one third of the patients experienced prolonged postoperative pain (2–14 days after the procedure), which was treated with oral analgesics (Table 2). One patient had a mild cutaneous infection postoperatively requiring no treatment. In further 2 patients, temporary peroneal palsy and minor bleeding were observed postoperatively (n = 1 each), which neither required any intervention nor treatment. As illustrated in Figure 4, leg length discrepancy did not change at FH when compared to preoperative measures (n = 51, p = 0.59). Furthermore, the HKA angle was assessed radiologically before epiphysiodesis surgery and at FH (Table 2). None of the patients needed an intervention or experienced any physical problems related to the surgery when followed until FH.

Table 2.

Safety and complications of epiphysiodesis

Characteristics and complicationsCases, n (%)
Leg length difference* 
 Before surgery 0.14±0.08 (range 0–1.4 cm) 
 After surgery 0.02±0.09 (range 0–1.5 cm) 
Hip-knee-ankle (HKA) angle 
 Δ HKA value ≤2 degrees 35 (76) 
 Δ HKA value >2 degrees 11 (24; 2.2–8.3°) 
Mild complications 
 Postoperative pain (2–14 days) 25 (38) 
Moderate complications 
 Temporary peroneal palsy 1 (1.4) 
 Minor bleeding 1 (1.4) 
 Subcutaneous infection 1 (1.4) 
Characteristics and complicationsCases, n (%)
Leg length difference* 
 Before surgery 0.14±0.08 (range 0–1.4 cm) 
 After surgery 0.02±0.09 (range 0–1.5 cm) 
Hip-knee-ankle (HKA) angle 
 Δ HKA value ≤2 degrees 35 (76) 
 Δ HKA value >2 degrees 11 (24; 2.2–8.3°) 
Mild complications 
 Postoperative pain (2–14 days) 25 (38) 
Moderate complications 
 Temporary peroneal palsy 1 (1.4) 
 Minor bleeding 1 (1.4) 
 Subcutaneous infection 1 (1.4) 

*Values are presented as mean ± standard error of mean.

Fig. 4.

Leg length difference (cm) at time of epiphysiodesis surgery and at FH. No significant difference could be observed between the two time points (p = 0.59; n = 51).

Fig. 4.

Leg length difference (cm) at time of epiphysiodesis surgery and at FH. No significant difference could be observed between the two time points (p = 0.59; n = 51).

Close modal

We here report data supporting that bilateral epiphysiodesis is an efficient and safe method to reduce FH in girls and boys with extreme tall stature. The procedure limited further leg growth in all patients. The reduction in FH compared to the preoperative prediction was larger in boys than in girls and when performed at an earlier bone age. No serious side effects were identified.

In tall boys, we report a higher reduction (8.6 cm) in FH compared to the preoperative prediction which is slightly more than what was earlier reported from the Netherlands and Sweden (6.4–7.0 cm) [27‒29]. However, it should be emphasized that the bone age at time of surgery was inversely related to the height reduction and when bone age exceeded 14.0 years, the mean height reduction in boys was <4.0 cm. In tall girls, bilateral epiphysiodesis was found to be less effective than in boys reducing FH by a mean of 3.6 cm which is less than what was earlier reported from the Netherlands (5.9 cm) [27, 28]. This difference is mostly due to the fact that the Dutch study only included girls with a bone age below 12.5 years in contrast to our study where no such restriction was applied. Indeed, when only assessing height reduction in girls with a bone age <12.5 years at the time of surgery, the mean height reduction was larger (4.6 cm). Taken together, this underlines the importance of not performing the procedure too late. To ensure a reasonable height reduction, we suggest that the procedure is only offered to highly motivated extremely tall adolescents with a bone age not exceeding 12.5 years in girls and 14.0 years in boys.

Most tall-stature patients have relatively long legs in comparison to their upper body segment [29, 36]. As expected, the relative sitting height increased in all patients after bilateral epiphysiodesis; therefore, the relative sitting height ended up closer to the mean in most patients. However, in those few patients who have a close to normal relative sitting height prior to surgery, it is important to inform about the risk of ending up with relatively short legs, especially if the procedure is performed when the predicted remaining growth potential is large.

We here report no serious complications. Importantly, no significant leg length difference or angular deformity could be observed. Complications reported (temporary peroneal palsy, subcutaneous infection, and minor bleeding in one patient each) did not require any re-intervention. In other studies, complication rates were similar, and reported complications included axis deformity, prominent head of fibula as well as infections, temporary nerve injury [28], and exostosis at the fibula [29]. Although complication rates are low, epiphysiodesis is still an invasive procedure and performed in otherwise healthy individuals. To minimize the risks, the procedure should therefore only be performed after thorough evaluation by a multidisciplinary team including expertise in pediatric endocrinology and pediatric orthopedic surgery.

This study has several limitations. First, FH predictions may be imprecise, especially in tall stature patients [11, 18]. In order to reduce the prediction error, all X-rays were read by two blinded experienced readers, and the mean bone age was used for FH predictions. Second, although none of the patients/families expressed their dissatisfaction with the procedure at regular follow-up visits, patient satisfaction and quality of life were not assessed in a standardized manner. Third, an untreated control group was not included which of course would have been desired, although for practical and technical reasons, this was not possible. Lastly, we did not follow up patients after having reached FH, and any complications that may appear later in life can therefore not be excluded.

In summary, our study suggests that bilateral epiphysiodesis is an effective and safe method to reduce FH in extremely tall boys and girls. The desired height reduction was greater in boys and when performed at a younger bone age. Although no serious complications were identified, we still recommend that all patients undergoing this procedure are followed up in a structured way to early detect any rare complications allowing timely treatment.

This study protocol was reviewed and approved by the Local Ethical Committee (Lokala Forskningsetikkommittén Nord vid Karolinska Sjukhuset), approval number 99-082 (date: 01. March 1999). Written informed consents were obtained before the procedure from the patients as well as their legal guardians.

The authors have no conflicts of interest to declare.

LS received funding from the Swedish Research Council (Grant No. 2020-02025), Region Stockholm (ALF), Karolinska Institutet, Frimurare-Barnhuset Stockholm, and Märta och Gunnar V. Philipsons Stiftelse. TA received funding from the Swiss National Science Foundation (Postdoc Mobility Fellowship, P2ZHP3_191254), the ESPE (European Society for Pediatric Endocrinology) Research Fellowship, sponsored by Novo Nordisk A/S, and from the Foundation Frimurare Barnhuset in Stockholm. EB received funding from Sällskapet Barnavård and the Foundation Frimurare Barnhuset in Stockholm. The funders had no role in the design, data collection, data analysis, and reporting of this study.

Concept and design, analysis and interpretation of data, and critical revision of the manuscript: T.A., E.B., H.W., D.C., and L.S.; acquisition of the data: T.A. and E.B.; drafting of the manuscript: T.A. All authors read and approved the final manuscript.

Additional Information

Tim R.J. Aeppli and Emelie Benyi shared first authorship.

Data are not openly available due to the fact that this study contains sensitive data, and the participants of this study did not give written consent for their data to be shared publicly. Further inquiries can be directed to the corresponding author.

1.
Albuquerque
EVA
,
Scalco
RC
,
Jorge
AAL
.
Management of endocrine disease: diagnostic and therapeutic approach of tall stature
.
Eur J Endocrinol
.
2017
;
176
(
6
):
R339
53
. .
2.
Simm
PJ
,
Werther
GA
.
Child and adolescent growth disorders: an overview
.
Aust Fam Physician
.
2005
;
34
(
9
):
731
7
.
3.
Verge
CF
,
Mowat
D
.
Overgrowth
.
Arch Dis Child
.
2010
;
95
(
6
):
458
63
. .
4.
de Onis
M
,
Onyango
AW
,
Borghi
E
,
Garza
C
,
Yang
H
,
WHO Multicentre Growth Reference Study Group
.
Comparison of the world health organization (WHO) child growth standards and the national center for health statistics/WHO international growth reference: implications for child health programmes
.
Public Health Nutr
.
2006
;
9
(
7
):
942
7
. .
5.
de Onis
M
,
Onyango
AW
,
Borghi
E
,
Siyam
A
,
Nishida
C
,
Siekmann
J
.
Development of a WHO growth reference for school-aged children and adolescents
.
Bull World Health Organ
.
2007
;
85
(
9
):
660
7
. .
6.
Werner
B
,
Bodin
L
.
Growth from birth to age 19 for children in Sweden born in 1981: descriptive values
.
Acta Paediatr
.
2006
;
95
(
5
):
600
13
. .
7.
Wikland
KA
,
Luo
ZC
,
Niklasson
A
,
Karlberg
J
.
Swedish population-based longitudinal reference values from birth to 18 years of age for height, weight and head circumference
.
Acta Paediatr
.
2002
;
91
(
7
):
739
54
. .
8.
Wahlstrom
J
,
Burström
L
,
Nilsson
T
,
Järvholm
B
.
Risk factors for hospitalization due to lumbar disc disease
.
Spine (Phila Pa 1976)
.
2012
;
37
(
15
):
1334
9
. .
9.
Pyett
P
,
Rayner
J
,
Venn
A
,
Bruinsma
F
,
Werther
G
,
Lumley
J
.
Using hormone treatment to reduce the adult height of tall girls: are women satisfied with the decision in later years
.
Soc Sci Med
.
2005
;
61
(
8
):
1629
39
. .
10.
Kuh
DJ
,
Coggan
D
,
Mann
S
,
Cooper
C
,
Yusuf
E
.
Height, occupation and back pain in a national prospective study
.
Br J Rheumatol
.
1993
;
32
(
10
):
911
6
. .
11.
Binder
G
,
Grauer
ML
,
Wehner
AV
,
Wehner
F
,
Ranke
MB
.
Outcome in tall stature. Final height and psychological aspects in 220 patients with and without treatment
.
Eur J Pediatr
.
1997
;
156
(
12
):
905
10
. .
12.
Bramswig
JH
,
von Lengerke
HJ
,
Schmidt
H
,
Schellong
G
.
The results of short-term (6 months) high-dose testosterone treatment on bone age and adult height in boys of excessively tall stature
.
Eur J Pediatr
.
1988
;
148
(
2
):
104
6
. .
13.
Jackson
LA
,
Ervin
KS
.
Height stereotypes of women and men - the liabilities of shortness for both sexes
.
J Soc Psychol
.
1992
;
132
(
4
):
433
45
. .
14.
Judge
TA
,
Cable
DM
.
The effect of physical height on workplace success and income: preliminary test of a theoretical model
.
J Appl Psychol
.
2004
;
89
(
3
):
428
41
. .
15.
Chu
S
,
Geary
K
.
Physical stature influences character perception in women
.
Personal Individual Differences
.
2005
;
38
(
8
):
1927
34
. .
16.
Drop
SL
,
De Waal
WJ
,
De Muinck Keizer-Schrama
SM
.
Sex steroid treatment of constitutionally tall stature
.
Endocr Rev
.
1998
;
19
(
5
):
540
58
. .
17.
Venn
A
,
Bruinsma
F
,
Werther
G
,
Pyett
P
,
Baird
D
,
Jones
P
, et al
.
Oestrogen treatment to reduce the adult height of tall girls: long-term effects on fertility
.
Lancet
.
2004
;
364
(
9444
):
1513
8
. .
18.
de Waal
WJ
,
Greyn-Fokker
MH
,
Stijnen
T
,
van Gurp
EA
,
Toolens
AM
,
de Munick Keizer-Schrama
SM
, et al
.
Accuracy of final height prediction and effect of growth-reductive therapy in 362 constitutionally tall children
.
J Clin Endocrinol Metab
.
1996
;
81
(
3
):
1206
16
. .
19.
de Waal
WJ
,
Torn
M
,
de Muinck Keizer-Schrama
SM
,
Aarsen
RS
,
Drop
SL
.
Long term sequelae of sex steroid treatment in the management of constitutionally tall stature
.
Arch Dis Child
.
1995
;
73
(
4
):
311
5
. .
20.
Radivojevic
U
,
Thibaud
E
,
Samara-Boustani
D
,
Duflos
C
,
Polak
M
.
Effects of growth reduction therapy using high-dose 17beta-estradiol in 26 constitutionally tall girls
.
Clin Endocrinol
.
2006
;
64
(
4
):
423
8
. .
21.
Weimann
E
,
Bergmann
S
,
Bohles
HJ
.
Oestrogen treatment of constitutional tall stature: a risk-benefit ratio
.
Arch Dis Child
.
1998
;
78
(
2
):
148
51
. .
22.
Blombäck
M
,
Hall
K
,
Ritzén
EM
.
Estrogen treatment of tall girls: risk of thrombosis
.
Pediatrics
.
1983
;
72
(
3
):
416
9
. .
23.
Jordan
HL
,
Hopper
JL
,
Thomson
RJ
,
Kavanagh
AM
,
Gertig
DM
,
Stone
J
, et al
.
Influence of high-dose estrogen exposure during adolescence on mammographic density for age in adulthood
.
Cancer Epidemiol Biomarkers Prev
.
2010
;
19
(
1
):
121
9
. .
24.
Tauber
MT
,
Tauber
JP
,
Vigoni
F
,
Harris
AG
,
Rochicchioli
P
.
Effect of the long-acting somatostatin analogue SMS 201-995 on growth rate and reduction of predicted adult height in ten tall adolescents
.
Acta Paediatr Scand
.
1990
;
79
(
2
):
176
81
. .
25.
Hindmarsh
PC
,
Pringle
PJ
,
Stanhope
R
,
Brook
CG
.
The effect of a continuous infusion of a somatostatin analogue (octreotide) for two years on growth hormone secretion and height prediction in tall children
.
Clin Endocrinol
.
1995
;
42
(
5
):
509
15
. .
26.
Noordam
C
,
van Daalen
S
,
Otten
BJ
.
Treatment of tall stature in boys with somatostatin analogue 201-995: effect on final height
.
Eur J Endocrinol
.
2006
;
154
(
2
):
253
7
. .
27.
Benyi
E
,
Berner
M
,
Bjernekull
I
,
Boman
A
,
Chrysis
D
,
Nilsson
O
, et al
.
Efficacy and safety of percutaneous epiphysiodesis operation around the knee to reduce adult height in extremely tall adolescent girls and boys
.
Int J Pediatr Endocrinol
.
2010
;
2010
:
740629
. .
28.
Goedegebuure
WJ
,
Jonkers
F
,
Boot
AM
,
Bakker-van Waarde
WM
,
van Tellingen
V
,
Heeg
M
, et al
.
Long-term follow-up after bilateral percutaneous epiphysiodesis around the knee to reduce excessive predicted final height
.
Arch Dis Child
.
2018
;
103
(
3
):
219
23
. .
29.
Odink
RJ
,
Gerver
WJ
,
Heeg
M
,
Rouwé
CW
,
van Waarde
WMB
,
Sauer
PJ
.
Reduction of excessive height in boys by bilateral percutaneous epiphysiodesis around the knee
.
Eur J Pediatr
.
2006
;
165
(
1
):
50
4
. .
30.
Edmonds
EW
,
Stasikelis
PJ
.
Percutaneous epiphysiodesis of the lower extremity: a comparison of single- versus double-portal techniques
.
J Pediatr Orthop
.
2007
;
27
(
6
):
618
22
. .
31.
Inan
M
,
Chan
G
,
Littleton
AG
,
Kubiak
P
,
Bowen
JR
.
Efficacy and safety of percutaneous epiphysiodesis
.
J Pediatr Orthop
.
2008
;
28
(
6
):
648
51
. .
32.
Pyle
SI
,
Waterhouse
AM
,
Greulich
WW
.
Attributes of the radiographic standard of reference for the national health examination survey
.
Am J Phys Anthropol
.
1971
;
35
(
3
):
331
7
. .
33.
Bayley
N
,
Pinneau
SR
.
Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards
.
J Pediatr
.
1952
;
40
(
4
):
423
41
. .
34.
Sabharwal
S
,
Zhao
C
.
The hip-knee-ankle angle in children: reference values based on a full-length standing radiograph
.
J Bone Joint Surg Am
.
2009
;
91
(
10
):
2461
8
. .
35.
Whitehouse
JMRA.RH
.
Growth development record: sitting height and subischial leg length
.
Hertfordshire UK
:
Castlemead Publications
;
1978
.
36.
Brinkers
JM
,
Lamoré
PJ
,
Gevers
EF
,
Boersma
B
,
Wit
JM
.
The effect of oestrogen treatment on body proportions in constitutionally tall girls
.
Eur J Pediatr
.
1994
;
153
(
4
):
237
40
. .