Limb Lengthening & Reconstruction Center

The UCSF Limb Lengthening and Complex Reconstruction Center is a specialized center dedicated to providing comprehensive care for children with limb length discrepancies or deformities and associated conditions of the upper and lower extremities. Regardless of underlying complexity, these conditions require care from many specialists, and our multidisciplinary team has the training and experience to use advanced therapeutic and surgical techniques that ultimately enable children to reach their highest levels of function, mobility and comfort.

Our goal is to help your child be as active and functional as possible. We offer a full range of treatment options, both with and without surgery.

We welcome international patients seeking access to our innovative and unique care models. If you live outside the United States, please visit our International Services page for help coordinating care.

Advanced reconstruction techniques and multidisciplinary collaboration

Our team includes pediatric orthopedic surgeons with advanced skills in limb lengthening, deformity correction and complex limb reconstruction. Special expertise includes:

  • Orthopedic oncology
  • Orthopedic trauma
  • Rehabilitation medicine

Because we can offer the resources of a large pediatric research hospital, our patients have access to experts in numerous subspecialties. These include:

  • Hand surgery and microsurgery
  • Occupational therapy
  • Physical therapy
  • Plastic surgery
  • Prosthetics and orthotics
  • Sports medicine

Rehabilitation therapy is key to recovery. We provide comprehensive rehab services for children, with amenities including:

  • A dedicated inpatient rehabilitation unit
  • A 17,000-square-foot rehabilitation center, with a spacious physical therapy gym and an outdoor terrain park
  • Outpatient therapy access at all locations

Limb lengthening

Surgical techniques for limb lengthening harness the body's own healing ability through the regeneration of bone and soft tissues (such as skin, muscle, nerves and blood vessels). The medical method called distraction osteogenesis involves the gradual pulling apart (distraction) of a surgically cut bone, allowing for new bone growth (osteogenesis) in the created gap. That new bone hardens and becomes as strong as any other bone in the body.

Complex reconstructive surgery

Several methods may be helpful, depending on the specifics of your child's condition. These include changing the limb's shape and alignment using a variety of techniques and implants. Additionally, defects and deficiencies in soft tissues can be addressed through advanced procedures, such as soft tissue flaps, microvascular surgery and tendon transfers.

We offer expertise in the following techniques and services:

  • Advanced physical therapy
  • Amputation reconstruction
  • Bio-integrated and expandable prosthesis
  • Computerized hexapod external fixators
  • Customized orthotics and prosthetics
  • Electromyography
  • Guided growth
  • Hinged distraction across joints
  • Masquelet technique
  • Medical Botox therapy
  • Microvascular surgery and tissue transfer
  • Percutaneous osteotomy
  • Prenatal consultation
  • Remote-controlled magnetic lengthening nails

Conditions we treat

Our team is experienced in diagnosis and care for a range of pediatric disorders of the extremities, including:

  • Limb length discrepancy (upper or lower limb)
  • Upper and lower limb deficiencies
  • Congenital leg length conditions:
    • Congenital femoral deficiency (proximal femoral focal deformity)
    • Fibular deficiency/fibular hemimelia
    • Tibia deficiency/tibial hemimelia
  • Developmental limb deformities:
    • Blount's disease
    • Congenital pseudoarthrosis of the tibia
  • Acquired deformities:
    • Deformities caused by noncancerous or cancerous tumors
    • Infection in a bone (osteomyelitis) or joint (septic arthritis)
    • Soft tissue scarring, such as may occur after burns or multiple surgeries for clubfoot correction
    • Traumatic injuries, including growth plate fractures, malunion (poor alignment in a healed fracture), nonunion (an incompletely healed fracture), shortening and deformity due to bone loss
  • Short stature:
    • Achondroplasia and other bone growth disorders
    • Limb length and angular deformities linked to dwarfism
  • Pediatric hip disorders, such as:
    • Developmental coxa vara
    • Legg-Calve-Perthes disease
    • Slipped capital femoral epiphysis
  • Limb differences linked to complex syndromes, such as:
    • Amniotic band syndrome
    • Apert syndrome
    • Arthrogryposis
    • Osteogenesis imperfecta
  • Bone loss as a result of an injury, tumor or infection
  • Early stages of arthritis


The Limb Lengthening and Complex Reconstruction Center at UCSF Benioff Children's Hospital Oakland is directed by Sanjeev Sabharwal, MD.

With more than two decades of experience, Sabharwal has distinguished himself as a leader in the treatment of limb deformities in children. He is a frequent speaker at national and international orthopedic medicine symposiums and has served as president of the Limb Lengthening and Reconstruction Society. He is editor of a comprehensive clinical textbook titled Pediatric Lower Limb Deformities: Principles and Techniques of Management. He serves as deputy editor for two eminent orthopedic journals, Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research.

Sabharwal's research focuses on advancing the science of limb lengthening and limb deformity correction, including the technique of distraction osteogenesis. He examines patient-centered innovation, works to develop patient-reported outcome measures for limb deformities, and studies the motivations and impact of global orthopedic volunteerism.

Our locations (4)

    Awards & recognition

    • One of the nation's best in orthopedics

    • Ranked among the nation's best in 10 specialties

    International patients


    International Services

    If you're coming to UCSF from outside the U.S., we coordinate your child's appointments and provide other helpful services. Here's how to get started.


    Interpreter Services & Communication Assistance

    Interpreter services in many languages and TDDs are available for families that need help communicating with care teams. Here's how to access them.

    Plan your visit

    Preparing for your appointment

    What to Bring

    • Photo I.D.
    • Health insurance card
    • Insurance authorization, if required
    • Doctor's referral, if required
    • Recent test results related to your child's condition
    • List of medications, including dosages, plus any your child is allergic to
    • List of questions you may have
    • Device or paper for taking notes

    New visitor rules

    Before you head to the hospital, check our special COVID-19 rules for visitors. Thanks!


    Your Stay

    We offer valuable information to help you plan for your child's upcoming hospital stay. Find out about food services, family accommodations and more.

    Learn more

    Your Child's Care Team

    Our doctors, nurses, child life specialists and other providers have special training to care for children. Meet your child's care team.

    Learn more

    Interpreter Services & Communication Assistance

    Interpreter services in many languages and TDDs are available for families that need help communicating with care teams. Here's how to access them.

    Learn more

    Related clinics (1)

    orthopedic-clinic-320x320-2x 6

    Pediatric Orthopedic Clinic

    Pediatric Orthopedic Clinic

    San Francisco / Oakland / Greenbrae / San Mateo / San Ramon / Walnut Cre...

    Support services

    Child Life Services

    Activity rooms, pet therapy and more to help kids feel at home.

    Child Life

    Certified child life specialists ease the stress and anxiety of childhood illness through therapeutic play, schooling and family-focused support.


    Camp Winning Hands

    This overnight camp is for children with congenital hand and upper limb differences. Kids make friends in a fun, safe and supportive environment.

    Family Amenities

    Family-friendly amenities help you relax and take care of yourself while staying close to your child. We offer lounges, kitchens, showers, breastfeeding rooms and more.


    Social Services

    Social workers ease the effect of illness, injury and hospitalization on your family with counseling and assistance to help you navigate the challenges.


    Activity Rooms

    Activity rooms offer a relaxed environment for children of all ages. Features include a playroom, digital arts studio and teen lounge. Find out more.


    Art Therapy

    Art therapy helps kids and families express themselves, making it easier to cope with pediatric health issues. Group and bedside services are available.


    Music Therapy Program

    Board-certified music therapists help kids cope with illness and the feelings that come with it. Find out about group activities and bedside therapy.


    School Program

    Our schoolroom services and individual learning programs help children hospitalized at UCSF continue their education and get ready to return to school.


    School Re-Entry Program

    After hospitalization, we help kids return to school by educating staff and students about their needs and recommending needed accommodations. Read more.


    Individual Playtime & Instruction

    If your child can't be around other kids for medical reasons, you can sign up for private sessions in our activity and school rooms. Find out how.

    Family Resource Center

    We help families cope with the challenges of childhood illness and hospitalization in a relaxing environment where parents can get a much-needed break.


    Parent Support Program

    Weekly activities, including knitting, scrapbooking, chair massage and more, help family caregivers get a much-needed break. Find out more.


    Patient Relations

    Patient relations reps and nursing supervisors are here to answer questions and address concerns. Learn about your rights, how to reach us and more.


    Spiritual Care

    Chaplains help UCSF patients, families and staff cope with the spiritual and emotional challenges of childhood illness. Learn more.

    Feeling at home

    From bedside bingo to therapy dogs, we're here to help kids smile and feel more like themselves.

    Visit Child Life services