KNEE INSTABILITY DISCUSSION: FUNCTIONAL KNEE BRACING 2005 THE - - PowerPoint PPT Presentation

▶
knee instability
SMART_READER_LITE
LIVE PREVIEW

KNEE INSTABILITY DISCUSSION: FUNCTIONAL KNEE BRACING 2005 THE - - PowerPoint PPT Presentation

Oct 19, 2023 393 likes •1.1k views

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

slide-1
SLIDE 1

KNEE INSTABILITY

DISCUSSION:

FUNCTIONAL KNEE BRACING

ROBERT E. BRYAN, BOCO, LIC.

2005

slide-2
SLIDE 2

ALBERT EINSTEIN

“THE ONLY

SOURCE OF KNOWLEDGE IS EXPERIENCE”

“THE ONLY

SOURCE OF KNOWLEDGE IS EXPERIENCE”

slide-3
SLIDE 3

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

slide-4
SLIDE 4

KNEE BRACES

PROPHYLACTIC FUNCTIONAL

slide-5
SLIDE 5

PROPHYLACTIC KNEE BRACING

NO POSITIVE DATA RE-DIRECTS FORCES DIMINISHED AGILITY

slide-6
SLIDE 6

THE PROPER FUNCTIONAL BRACE DESIGN PROVIDES

AGILITY PROTECTION PROPRIOCEPTION

slide-7
SLIDE 7

NON-COMPLIANT PATIENTS

WASTE VALUABLE MEDICAL TEAM TIME AND RESOURCES

_____________________________

INSURANCE PROVIDER CONCERNS

slide-8
SLIDE 8

NO FUNCTIONAL BRACE REQUIRED-NWB ACTIVITIES

slide-9
SLIDE 9

RUNNERS DON’T WEAR FUNCTIONAL KNEE BRACES

GOLFERS DO!

DON’T FORGET THE BALL! DON’T FORGET THE BALL!

slide-10
SLIDE 10

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

slide-11
SLIDE 11

THE FINAL DECISION

ECONOMICS!

INSURANCE PROVIDER ISSUES!

VANITY CONCERNS!

slide-12
SLIDE 12

APPROACH WITH CAUTION

INTERNET AHEAD

slide-13
SLIDE 13

THE INTERNET KNEE BRACING SITES

493,000 KNEE BRACING SITES MANUFACTURERS SITES

CAUTION

slide-14
SLIDE 14

HUMAN ANATOMY

ORTHOTISTS PERCEPTION

slide-15
SLIDE 15

THE INTERNAL FRAME ENDOSKELETON

COMPRESSION ROTATION BLUNT FORCE AXIAL LOAD

slide-16
SLIDE 16

THE HUMAN KNEE

HYDRAULIC SYSTEM POLYCENTRIC JOINT FRAME FLEXORS AND EXTENDERS SENSORS SHOCK ABSORBER

slide-17
SLIDE 17

POLYCENTRIC JOINT

GLIDE PIVOT TWIST

CONTROLLED INSTABILITY

slide-18
SLIDE 18

ANATOMICAL DEFECTS

ACL TEAR PCL TEAR MCL SPRAIN PATELLAR TENDON TEAR MENISCAL TEAR CONDYLAR DEFECT

slide-19
SLIDE 19

JOINTS DIFFERENT ACTIONS

THE MOST COMPLEX NO ROTATION OR PIVOT (SINGLE AXIS)

STRENGTH AGILITY

(POLYCENTRIC)

slide-20
SLIDE 20

INTERNAL DERANGEMENT SURGICAL REPAIR

slide-21
SLIDE 21

EXOSKELETON

RUGGED DESIGN LIMITED MOBILITY VITAL SYSTEMS PROTECTED

LUNCH

slide-22
SLIDE 22

EARLY KNEE BRACING CONCEPTS

FLEXIBLE DESIGN / COST EFFECTIVE

slide-23
SLIDE 23

THE PRESENT AND PAST

JOE NAMETH

LENOX HILL DEROTATION BRACE CARBON AND TITANIUM STAINLESS AND SURGICAL TUBE

slide-24
SLIDE 24

FORM DICTATES FUNCTION

ROUND HOUSE IN GLENDORA, NEW JERSEY

F U N C T I O N ?

slide-25
SLIDE 25

THERE ARE LIMITS

MECHANICAL AND ANATOMICAL

slide-26
SLIDE 26

FUNCTIONAL LIMITATIONS

KNEE BRACE MASS LIMITS FLEXION EXTENSION STOPS LIMIT HYPEREXTENSION

slide-27
SLIDE 27

KNEE BRACING LIMITS

SOFT TISSUE CONTAINMENT

slide-28
SLIDE 28

GET IT RIGHT!

THE FIRST TIME

PROPER DESIGN PROPER FUNCTION PROPER INSTRUCTION

slide-29
SLIDE 29

“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

slide-30
SLIDE 30

THE BRACING PUZZLE

PROPRIOCEPTION VISUAL FEEDBACK

EXTERNAL STRUCTURE

KINESTHETICS

ORTHOSIS MIRROR JOINT LOCATION THE FEELING

slide-31
SLIDE 31

PROPRIOCEPTION

COMBINED INSTABILITY STRAPPING 10 DEGREE EXTENSION STOP TIBIAL SHELL

THE SENSATION OF SUPPORT AND JOINT PLACEMENT

slide-32
SLIDE 32

VISUAL FEEDBACK

slide-33
SLIDE 33

VISUAL FEEDBACK

SEEING IS BELIEVING

MIRROR

slide-34
SLIDE 34

THE ULTIMATE DECISION

BRACE TYPE AND FUNCTION

slide-35
SLIDE 35

GAIT/JOG LAG

CONTRIBUTING FACTORS

EXCESSIVE BRACE

LENGTH/WEIGHT

IMPROPER BRACE

TYPE/FUNCTION

POOR FIT

slide-36
SLIDE 36

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

slide-37
SLIDE 37

TUNNEL VISION LIMITS OPTIONS THINK OUTSIDE THE TUBE THINK THINK OUTSIDE OUTSIDE THE THE TUBE TUBE

slide-38
SLIDE 38

VARIETY OF BRACES

slide-39
SLIDE 39

SOFT KNEE BRACES

MEDIAL LATERAL MCL NON-CONTACT PARTIAL TEAR SPRAIN LIMIT ROM

slide-40
SLIDE 40

LOW QUALITY

JOINTS

LOW COST PRONE TO METAL FATIGUE AND

FAILURE

slide-41
SLIDE 41

HINGED BRACES

SINGLE AXIS

LOW COST/QUALITY HINGES CREATE DISTAL BRACE MIGRATION DURING KNEE FLEXION

NOT A POLYCENTRIC JOINT

slide-42
SLIDE 42

STRUCTURAL OVERLOAD

JOINTS FRAME MATERIAL FUNCTIONAL TYPE POOR QUALITY

FAILURE FAILURE

slide-43
SLIDE 43

ALUMINUM BRACES

MALLEABLE CUFFS LIGHT WEIGHT THIN UPRIGHTS DURABLE LIMITED CONTACT

slide-44
SLIDE 44

OFF THE SHELF BRACING

BRACE FITS 90 % POPULATION

RECENTLY IMPROVED MATERIALS, QUALITY AND FIT MODERATE CONTACT SPORTS

COST EFFECTIVE

slide-45
SLIDE 45

CUSTOM UNLOADER BRACE FROM CAST MOLD

3 TO 10 DEGREES VAR/VAL CONDYLAR DEFECT MENISCAL REPAIR MCL TEAR

slide-46
SLIDE 46

SYSTEMS FAILURE

HIGH IMPACT

ROCK

STRUCTURAL INTEGRITY COMPROMISED

slide-47
SLIDE 47

SPORT SPECIFIC BRACING

CUSTOM MANUFACTURED

MUST WITHSTAND TORQUE, HIGH IMPACT, AND AXIAL LOADS SPECIAL MATERIALS AND COMPONENTS

slide-48
SLIDE 48

SPORT SPECIFIC BRACING

slide-49
SLIDE 49

CUSTOM BRACE FROM CAST

THIN JOINTS INTIMATE FIT CUSTOM LENGTH CUSTOM STRAPPING

slide-50
SLIDE 50

CUSTOM MADE BRACE FROM CAST MOLD

TITANIUM JOINTS CARBON FIBER SHELL SUPERIOR STRAPPING ROTATIONAL CONTROL FLEXIBLE DESIGNS

slide-51
SLIDE 51

GENDER/AGE SPECIFIC KNEE BRACING

FEMALE ATHLETE ACTIVE SENIOR YOUNG ADULT

slide-52
SLIDE 52

CHAMELEON

COLOR IT PINK, ADD A FLOWER, GENDER CHANGE!

RESEARCH AND DEVELOPMENT

slide-53
SLIDE 53

GENDER SPECIFIC BRACING

MUST BE RUGGED LESS BULK SHORTER LENGTH LIGHTER WEIGHT

slide-54
SLIDE 54

THE YOUNGER ATHLETE SPORTS INJURIES PERFORMANCE PRESSURE

LIGAMENTOUS STRAINS AND SPRAINS JOINT SUBLUXATION/DISLOCATION GROWTH PLATE INJURIES

slide-55
SLIDE 55

BILATERAL KNEE BRACING

TREAT EACH EXTREMITY

INDIVIDUALLY

LOW PROFILE ORTHOSIS

CONSIDER

ABILITY AGILITY GAIT

slide-56
SLIDE 56

TOTAL CONTAINMENT

TRUE CUSTOM FROM MOLD HIGH IMPACT DIMINISHED AGILITY

slide-57
SLIDE 57

CUSTOM FUNCTIONAL BRACE ADD 5 DEGREES VAR/VAL

APPLIED TO ORTHOSIS

TO OFF-LOAD MENISCAL REPAIR, CONDYLER DEFECT OR MCL TEAR

slide-58
SLIDE 58

UNLOADING ORTHOSIS

CUSTOM

SINGLE JOINT BULKY ROTATES ON LIMB

slide-59
SLIDE 59

BRACE FROM PHOTOGRAPH

CUSTOM COMPONENT OLDER TECHNOLOGY MILD CONTACT

slide-60
SLIDE 60

BRACE FROM PHOTOGRAPH

CUSTOM COMPONENT SOFT THIGH SHELL UNLOADER MILD CONTACT

slide-61
SLIDE 61

ANTERIOR VIEW

FLEXIBLE THIGH CUFF RIGID TIBIAL SHELL WIDE JOINTS

slide-62
SLIDE 62

ATHLETES WHO PERFORM MORE THAN ONE MODALITY

REQUIRE A MULTI-FUNCTIONAL

BRACE DESIGN

FUNCTIONAL LIMITS

WARNING

slide-63
SLIDE 63

MANUFACTURER ETHICS ALSO, THE BRIDGE IS OUT!

slide-64
SLIDE 64

“SALES MAN OF THE YEAR” DOES HE UNDERSTAND?

BRACING CONCEPTS KNEE ANATOMY BRACE DESIGNS EVALS AND F/U’S

EASY STREET

slide-65
SLIDE 65

“SALESMAN OF THE YEAR”

0VER 10 0VER 10 BILLION

BILLION SOLD

SOLD NEVER AN EVALUATION OR NEVER AN EVALUATION OR FOLLOW FOLLOW-

  • UP

UP

I’M THE

MAN!

I’M THE

MAN!

slide-66
SLIDE 66

BRACING CONCEPTS?

HEIGHT 6’ 2’ WEIGHT 220 LBS. ACTIVITY LEVEL HIGH

MINIMAL CONTROL

slide-67
SLIDE 67

NOT MUCH THOUGHT BRACING CONCEPTS

SHORT CALF SHORT CALF COMPONENT COMPONENT

NO SOFT TISSUE CONTAINMENT NO ROTATIONAL CONTROL STRAPS OVER- TIGHTENED FOR STABILITY

slide-68
SLIDE 68

THE WRONG BRACE CHOICE

POOR PERFORMANCE

DELEGATES

slide-69
SLIDE 69

PATIENT COMPLIANCE

THE BEGINNING