Katie Garcin MK, LAT, ATC
DJO Global
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Bracing Classifications
Inside the ACL
Brace Technology
Hinge Technology
Brace Fitting Guidelines
Information delivered in this presentation is backed by clinical studies for DonJoy
braces.
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Prophylactic knee braces (Prevention)
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Rehabilitative knee braces (Biological)
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Functional knee braces (Mechanical Control)
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Unloader/offloader braces
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Prophylactic bracing can significantly reduce the
number of knee ligament injuries in a season.
Studies Support Facts:
◦ Football (contact): may decrease MCL sprain risk by 20-30%, RTP
time decreases.
◦ Motocross: reduces risk of injury to ACL by 50%
◦ Skiing: Reduce ACL re-injury by 3-times.
Reduce the risk of contact/high
impact knee ligament injuries
Albright JP et al. Medial Collateral Ligament Knee Sprains in College Football: Effectiveness of preventative braces. American Journal of Sports Medicine. 1994 22:1. 12-18
Sanders MS, CatesRA, Baker, MD, Barber-Westin SD, Gladin WM, Levy MS. Knee Injuries and the Use of Prophylactic knee bracing in Off-road Motorcycling: Results of a Large-Scale
Epidemiological Study. American Journal of Sports Medicine. 2011; 39: 1395-1400
Sterrett WI, Briggs KK, Farley T, Steadman JR. Effect of Functional Bracing on Knee Injury in Skiers with Anterior Cruciate Ligament Reconstruction: A prospective Cohort Study. 2006;
34:1581-1585
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Protect the healing graft
Allow protected (limited) motion of
injured knees or knees that have
been treated operatively (4 Pointsof-leverage)
◦ Decrease anterior tibial translation
Provide proprioceptive awareness
and feedback
Training in a brace with Fource Point
hinge can translate to greater flexion
angle at the knee bilaterally
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Provide stability and support during activity
◦ Return to Play with brace for extra support if
needed.
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Provide protection for the repaired ligament
Stabilize from anterioposterior forces
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Mainly, reduces strain on the ACL graft to
reduce risk of re-injury.
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Can a brace prevent tibial rotation?
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Preserve the life of a joint with arthritic conditions.
3 point load shifts compressive knee joint forces from the
degenerative compartment to the healthy compartment
Pull –
Push
** Uses rotation
200,000
ACL injury
cases per year in U.S.
ACL injuries
Majority of
occur while playing
agility sports.
70% of ACL injuries are
sustained through non-
contact mechanisms
Most prevalent in active persons
15-45 years of age.
Kim, J. (2009, January 1). Anterior Cruciate Ligament Injury. . Retrieved , from
http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anterior-cruciateligament-injury-acl/
The re-injury rate for the
ACL reconstructed knee is
Women are 2-8 times
more likely to sustain an
ACL injury playing sports.
5-10%
Psychological factors, primarily
fear of re-injury influence the
ability to return to play
Kim, J. (2009, January 1). Anterior Cruciate Ligament Injury. . Retrieved , from
http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/anteriorcruciate-ligament-injury-acl/
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Passive Brace Frame:
◦ passive braces are used to support the static
components of the joint, e.g. ligaments, cartilage,
and bone geometry. Passive braces don’t
consistently address instabilities, which increases
the risk of injury
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Dynamic Brace Frame:
◦ Dynamic braces utilize unique strapping and hinge
configurations to carefully disperse pressure on the
joints, ligaments, and bone, throughout the soft
tissue and surrounding muscles of the joint
Dynamic bracing
system
 Designed to reduce
the strain on the ACL
 Unique cuff &
strapping
configuration,
providing a net
differential posterior
force to the tibia
preventing anterior
movement
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1
3
4
2
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Point 1 (Anterior Thigh
Cuff/Posterior thigh Strap)
◦ Anchors the femur
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1
Point 2 (Posterior Calf
Cuff/Anterior tibial strap)
3
◦ Anchors the tibia
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Point 3 (Posterior Distal
Thigh Strap)
◦ Pushes the femur anteriorly
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Point 4 (Anterior Proximal
Tibia Strap)
◦ Applies constant posterior
load to prevent anterior tibial
translation
4
2
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Polycentric Hinge
◦ Thigh frame and calf
frame gears connect
through 2 different
pivoting points within
hinge
◦ Stabilizes the knee
while matching natural
knee kinematics
◦ Maximizes
anterior/posterior and
varus/valgus
stabilizing forces of
the brace
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Fource Point Hinge
◦ Patented - designed to keep the knee out of the “at risk” position
◦ Leaf spring mechanism provides five levels of resistance during
extension
◦ Applies resistance during knee extension
◦ Resistance engages in last 250 of extension
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How does the Fource Point hinge perform clinically?
Immediate Effects of a Knee Brace With a Constraint to Knee
Extension on Knee Kinematics and Ground Reaction Forces in a
Stop-Jump Task
Bing Yu,*† PhD, Daniel Herman,† MS, William Lu,‡ PhD, Donald T. Kirkendall,† PhD, and William E. Garrett,† MD, PhD From
the †University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and the ‡University of Hong Kong, Hong Kong
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Hypothesis: 1) Training in FP hinge for 4 weeks will result in increase knee flexion
angle and decreased ground reaction forces during stop jump and side cutting
tasks 2) the effects of the training will be retained for up to 4 weeks.
24 recreational athletes, Group A (1st 4 weeks = no brace, 2nd 4 weeks = brace)
Group B (1st 4 weeks = brace, 2nd 4 weeks = no brace)
Average increase of 5° in Knee Flexion Angle at Landing
Training with FourcePoint (hinge) resulted in increased flexion angles and
decreased peak impact ground-reaction forces during stop-jump and side-cutting
tasks after 4 weeks
Training effects were retained up to 4 weeks (Group B)
Conclusion:FourcePoint (hinge) is a useful training tool for the prevention of ACL
injuries
Knee Flexion Angle at Landing
No Brace
35
p = 0.001
30
Degrees
Brace
p = 0.001
25
20
15
10
5
0
Male
Female
Does 5° flexion angle increase matter?
- The anterior shear force applied on the tibia will be reduced by 9%
for females & 13% for males (Nunley et al., 2003)
- The decrease in anterior shear force on the tibia will substantially
reduce the load on the ACL
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Initial preparation
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Brace & Hinge Placement
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Anti-Migration Band
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Securing Straps
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Check fit & Re-tighten
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Initial Preparation
• Sit on the edge of a
firm stable chair
• Knee slightly bent
(45°) and foot flat on
the floor
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Brace & Hinge
placement
◦ With straps undone –
step through or place
the brace on the leg
◦ Center the hinge at the
top of the patella
◦ Push hinges slightly
back to the midline of
the knee
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Anti-Migration
Band
◦ Secure AntiMigration band
superior to the calf
for a snug fit
◦ Band sits on top of
the calf to prevent
downward translation
Securing Straps
1
2
3
Straps should
have little
tension
4
5
Strap should
be secure and
snug
Proper Hinge Placement
Good Fit
Bad Fit
Proper Alignment
Good Fit
Bad Fit
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Troubleshoot
◦ Look for excessive
gapping
◦ Atrophy?
 Atrophy Kits for extra
padding
◦ Knee width too wide?
 Air condyle pads or
thicker foam pad
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What to do when your brace is slipping down...
DO NOT: Reach for the thigh straps to tighten
DO: Re-tighten/placement of Anti-Migration Band
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Thank you!!!