ROBERT E. BRYAN, BOCO, LIC. KNEE INSTABILITY DISCUSSION: FUNCTIONAL KNEE BRACING 2005
“ THE ONLY “ THE ONLY SOURCE OF SOURCE OF KNOWLEDGE IS KNOWLEDGE IS EXPERIENCE” EXPERIENCE” ALBERT EINSTEIN
BRACING POSITION STATEMENT A.A.O.S. � PROPHYLACTIC BRACING -NOT PROVEN EFFECTIVE AND MAY CONTRIBUTE TO INJURY � FUNCTIONAL BRACING -CAN BE EFFECTIVE IN MANY TREATMENT PROGRAMS-EFFICACY HAS BEEN DEMONSTRATED BY SCIENTIFIC STUDIES
KNEE BRACES PROPHYLACTIC FUNCTIONAL
PROPHYLACTIC KNEE BRACING � NO POSITIVE DATA � RE-DIRECTS FORCES � DIMINISHED AGILITY
THE PROPER FUNCTIONAL BRACE DESIGN PROVIDES � AGILITY � PROTECTION � PROPRIOCEPTION
NON-COMPLIANT PATIENTS WASTE VALUABLE MEDICAL TEAM TIME AND RESOURCES _____________________________ INSURANCE PROVIDER CONCERNS
NO FUNCTIONAL BRACE REQUIRED-NWB ACTIVITIES
RUNNERS DON’T WEAR FUNCTIONAL KNEE BRACES DON’T DON’T FORGET FORGET THE BALL! THE BALL! GOLFERS DO!
DETERMINING FACTORS FUNCTIONAL KNEE BRACE USAGE DECISION OF HEALTH CARE TEAM AND � PATIENT TYPE OF INJURY/SURGICAL REPAIR � PLANNED POST SURGICAL ACTIVITIES � ( VOCATION/SPORTS) GEOGRAPHY/DEMOGRAPHICS/POSSIBLE � LITIGATION
THE FINAL DECISION ECONOMICS! INSURANCE PROVIDER ISSUES! VANITY CONCERNS!
APPROACH WITH CAUTION INTERNET AHEAD
THE INTERNET KNEE BRACING SITES CAUTION � 493,000 KNEE BRACING SITES � MANUFACTURERS SITES
HUMAN ANATOMY PERCEPTION ORTHOTISTS
THE INTERNAL FRAME ENDOSKELETON � COMPRESSION � ROTATION � BLUNT FORCE � AXIAL LOAD
THE HUMAN KNEE � HYDRAULIC SYSTEM � POLYCENTRIC JOINT � FRAME � FLEXORS AND EXTENDERS � SENSORS � SHOCK ABSORBER
POLYCENTRIC JOINT CONTROLLED INSTABILITY � GLIDE � PIVOT � TWIST
ANATOMICAL DEFECTS � ACL TEAR � PCL TEAR � MCL SPRAIN � PATELLAR TENDON TEAR � MENISCAL TEAR � CONDYLAR DEFECT
JOINTS DIFFERENT ACTIONS AGILITY STRENGTH THE MOST COMPLEX (POLYCENTRIC) NO ROTATION OR PIVOT (SINGLE AXIS)
INTERNAL DERANGEMENT SURGICAL REPAIR
EXOSKELETON � RUGGED DESIGN LUNCH � LIMITED MOBILITY � VITAL SYSTEMS PROTECTED
EARLY KNEE BRACING CONCEPTS FLEXIBLE DESIGN / COST EFFECTIVE
THE PRESENT AND PAST JOE NAMETH LENOX HILL DEROTATION BRACE CARBON AND STAINLESS AND TITANIUM SURGICAL TUBE
F ORM DICTATES FUNCTION F U N C T I O N ? ROUND HOUSE IN GLENDORA, NEW JERSEY
THERE ARE LIMITS MECHANICAL AND ANATOMICAL
FUNCTIONAL LIMITATIONS KNEE BRACE MASS LIMITS FLEXION EXTENSION STOPS LIMIT HYPEREXTENSION
KNEE BRACING LIMITS SOFT TISSUE CONTAINMENT
GET IT RIGHT! � THE FIRST TIME � PROPER DESIGN � PROPER FUNCTION � PROPER INSTRUCTION
“IT JUST HAPPENED”? NOT REALLY ! � M.O.I. � PATIENT HISTORY � MRI/X-RAY REPORTS � SURGICAL NOTES � FUTURE ACTIVITIES EDUCATED APPROACH BRACE TYPE AND FUNCTIONAL DESIGN
THE BRACING PUZZLE MIRROR VISUAL FEEDBACK PROPRIOCEPTION THE FEELING EXTERNAL STRUCTURE JOINT ORTHOSIS KINESTHETICS LOCATION
PROPRIOCEPTION THE SENSATION OF SUPPORT AND JOINT PLACEMENT COMBINED INSTABILITY STRAPPING 10 DEGREE EXTENSION STOP TIBIAL SHELL
VISUAL FEEDBACK
VISUAL FEEDBACK MIRROR SEEING IS BELIEVING
THE ULTIMATE DECISION BRACE TYPE AND FUNCTION
GAIT/JOG LAG CONTRIBUTING FACTORS � EXCESSIVE BRACE LENGTH/WEIGHT � IMPROPER BRACE TYPE/FUNCTION � POOR FIT
PRE-MEASUREMENT DRILL TREADMILL OR STATIONARY BIKE A TWO MINUTE WARM-UP TO DEFINE QUAD, HAMSTRING , AND GASTROC MUSCULATURE INSURES A BETTER BRACE FIT DURING AGGRESSIVE ATHLETICS
TUNNEL VISION LIMITS OPTIONS THINK THINK THINK OUTSIDE OUTSIDE OUTSIDE THE TUBE TUBE THE TUBE THE
VARIETY OF BRACES
SOFT KNEE BRACES � MEDIAL � LATERAL � MCL � NON-CONTACT � PARTIAL TEAR � SPRAIN � LIMIT ROM
J OINTS LOW QUALITY � LOW COST � PRONE TO METAL FATIGUE AND FAILURE
HINGED BRACES SINGLE AXIS LOW COST/QUALITY HINGES CREATE DISTAL BRACE MIGRATION DURING KNEE FLEXION NOT A POLYCENTRIC JOINT
STRUCTURAL OVERLOAD � JOINTS � FRAME MATERIAL � FUNCTIONAL TYPE � POOR QUALITY FAILURE FAILURE
ALUMINUM BRACES � MALLEABLE CUFFS � LIGHT WEIGHT � THIN UPRIGHTS � DURABLE � LIMITED CONTACT
OFF THE SHELF BRACING � BRACE FITS 90 % POPULATION RECENTLY IMPROVED MATERIALS, QUALITY AND FIT MODERATE CONTACT SPORTS COST EFFECTIVE
CUSTOM UNLOADER BRACE FROM CAST MOLD � 3 TO 10 DEGREES VAR/VAL � CONDYLAR DEFECT � MENISCAL REPAIR � MCL TEAR
SYSTEMS FAILURE STRUCTURAL INTEGRITY COMPROMISED ROCK HIGH IMPACT
SPORT SPECIFIC BRACING CUSTOM MANUFACTURED MUST WITHSTAND TORQUE, HIGH IMPACT, AND AXIAL LOADS SPECIAL MATERIALS AND COMPONENTS
SPORT SPECIFIC BRACING
CUSTOM BRACE FROM CAST � THIN JOINTS � INTIMATE FIT � CUSTOM LENGTH � CUSTOM STRAPPING
CUSTOM MADE BRACE FROM CAST MOLD � TITANIUM JOINTS � CARBON FIBER SHELL � SUPERIOR STRAPPING � ROTATIONAL CONTROL � FLEXIBLE DESIGNS
GENDER/AGE SPECIFIC KNEE BRACING FEMALE ATHLETE ACTIVE SENIOR YOUNG ADULT
CHAMELEON RESEARCH AND DEVELOPMENT COLOR IT PINK, ADD A FLOWER, GENDER CHANGE!
GENDER SPECIFIC BRACING � MUST BE RUGGED � LESS BULK � SHORTER LENGTH � LIGHTER WEIGHT
THE YOUNGER ATHLETE SPORTS INJURIES LIGAMENTOUS STRAINS AND SPRAINS JOINT SUBLUXATION/DISLOCATION GROWTH PLATE INJURIES PERFORMANCE PRESSURE
BILATERAL KNEE BRACING � TREAT EACH EXTREMITY INDIVIDUALLY � LOW PROFILE ORTHOSIS CONSIDER ABILITY AGILITY GAIT
TOTAL CONTAINMENT � TRUE CUSTOM � FROM MOLD � HIGH IMPACT � DIMINISHED AGILITY
CUSTOM FUNCTIONAL BRACE ADD 5 DEGREES VAR/VAL APPLIED TO ORTHOSIS TO OFF-LOAD MENISCAL REPAIR, CONDYLER DEFECT OR MCL TEAR
UNLOADING ORTHOSIS CUSTOM � SINGLE JOINT � BULKY � ROTATES ON LIMB
BRACE FROM PHOTOGRAPH � CUSTOM COMPONENT � OLDER TECHNOLOGY � MILD CONTACT
BRACE FROM PHOTOGRAPH � CUSTOM COMPONENT � SOFT THIGH SHELL � UNLOADER � MILD CONTACT
ANTERIOR VIEW FLEXIBLE THIGH CUFF WIDE JOINTS RIGID TIBIAL SHELL
ATHLETES WHO PERFORM MORE THAN ONE MODALITY � REQUIRE A MULTI-FUNCTIONAL BRACE DESIGN WARNING � FUNCTIONAL LIMITS
MANUFACTURER ETHICS ALSO, THE BRIDGE IS OUT!
“SALES MAN OF THE YEAR” DOES HE UNDERSTAND? EAS Y � BRACING CONCEPTS STREET � KNEE ANATOMY � BRACE DESIGNS � EVALS AND F/U’S
“SALESMAN OF THE YEAR” I’M THE I’M THE MAN! MAN! BILLION SOLD 0VER 10 BILLION SOLD 0VER 10 NEVER AN EVALUATION OR NEVER AN EVALUATION OR FOLLOW- FOLLOW -UP UP
BRACING CONCEPTS? � HEIGHT 6’ 2’ � WEIGHT 220 LBS. � ACTIVITY LEVEL HIGH � MINIMAL CONTROL
NOT MUCH THOUGHT BRACING CONCEPTS NO SOFT STRAPS OVER - TISSUE CONTAINMENT TIGHTENED FOR STABILITY SHORT CALF SHORT CALF COMPONENT COMPONENT NO ROTATIONAL CONTROL
THE WRONG BRACE CHOICE DELEGATES POOR PERFORMANCE
PATIENT COMPLIANCE THE BEGINNING
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