Tibial lengthening in congenital pseudoarthrosis of the tibia: a scoping review

BACKGROUND: Congenital pseudoarthrosis of the tibia (CPT) is a rare, sinister condition that is often associated with neurofibromatosis type 1 (NF1). Even after achieving union, patients frequently present with significant leg length discrepancy (LLD) due to growth disturbance and repeated reconstructive surgeries. Tibial lengthening using distraction osteogenesis is commonly performed, yet outcomes and complications remain poorly understood. OBJECTIVE: To systematically map the available literature on tibial lengthening in CPT, describe surgical techniques, summarize reported outcomes, and identify research gaps. METHODS: A scoping review was conducted following Arksey and O'Malley's framework and the PRISMA-ScR guidelines. The PubMed, Embase, Scopus, Web of Science and Cochrane Library databases were searched. Eligible studies included those reporting tibial lengthening during CPT. Data on patient demographics, surgical techniques, length achieved, union rates, complications, and follow-up were extracted. RESULTS: Thirty-one studies involving 486 patients were included. All studies were retrospective. The mean age at lengthening ranged from 3.2 to 33.7 years. NF1 was present in 70% of the patients. The Ilizarov external fixator in isolation or with hybrid techniques was the most frequently reported lengthening modality. The mean lengthening achieved was 5.5 cm (range 1.5-10.2 cm). The most common site of lengthening was through proximal tibial osteotomy followed by physeal distraction. Complications such as pin tract infection, regenerate fractures and tibial bowing deformities were commonly encountered. The follow-up period ranged from 1.6 to 24 years. CONCLUSIONS: Tibial lengthening is feasible in CPT and can achieve meaningful limb length equalization. However, complication rates remain high, and evidence is limited by the small number of retrospective studies. Standardized outcome reporting and prospective multicenter collaboration are needed to optimize care.