Functional Brace Fitting for Athletic TrainersKatie Garcin MK, LAT, ATC

DJO Global

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.

Objective

Bracing Classifications

Prophylactic knee braces (Prevention)

Rehabilitative knee braces (Biological)

Functional knee braces (Mechanical Control)

Unloader/offloader braces

Bracing Classifications

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

Prophylactic Bracing

Rehabilitative Bracing

Protect the healing graft Allow protected (limited) motion of

injured knees or knees that have been treated operatively (4 Points-of-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

Provide stability and support during activity◦ Return to Play with brace for extra support if

needed. Provide protection for the repaired ligament Stabilize from anterioposterior forces

Mainly, reduces strain on the ACL graft to reduce risk of re-injury.

Can a brace prevent tibial rotation?

Functional Bracing

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

Off-Loader Bracing

PushPull – ** Uses rotation

200,000 ACL injury cases per year in U.S.

Majority of ACL injuries 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-cruciate-ligament-injury-acl/

Women are 2-8 times more likely to sustain an ACL injury playing sports.

The re-injury rate for the ACL reconstructed knee

is 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/anterior-cruciate-ligament-injury-acl/

Brace Technology

Bracing Technology

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

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 vs Passive Braces

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

4 Points of Leverage1

2

3

4

Point 1 (Anterior Thigh Cuff/Posterior thigh Strap)◦ Anchors the femur

Point 2 (Posterior Calf Cuff/Anterior tibial strap)◦ Anchors the tibia

Point 3 (Posterior Distal Thigh Strap)◦ Pushes the femur anteriorly

Point 4 (Anterior Proximal Tibia Strap)◦ Applies constant posterior load to

prevent anterior tibial translation

4 Points of Leverage1

2

3

4

Hinge Technology

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

Hinge Technology

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

Hinge Technology

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

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

Fource Point Hinge

Fource Point HingeKnee Flexion Angle at Landing

0

5

10

15

20

25

30

35

Male Female

Deg

reesNo Brace Brace

p = 0.001

p = 0.001

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

Brace Fitting Guidelines

Initial preparation

Brace & Hinge Placement

Anti-Migration Band

Securing Straps

Check fit & Re-tighten

Instructions for proper brace fitting

Initial Preparation

• Sit on the edge of a firm stable chair

• Knee slightly bent (45°) and foot flat on the floor

Brace Fitting

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

Brace Fitting

Anti-Migration Band

◦ Secure Anti-Migration band superior to the calf for a snug fit

◦ Band sits on top of the calf to prevent downward translation

Brace Fitting

Brace Fitting1 2 3

45

Strap should be secure and

snug

Straps should have little

tension

Securing Straps

Brace FittingProper Hinge Placement

Good Fit Bad Fit

Brace FittingProper Alignment

Good Fit Bad Fit

Troubleshoot◦ Look for excessive

gapping

◦ Atrophy? Atrophy Kits for extra

padding

◦ Knee width too wide? Air condyle pads or

thicker foam pad

Brace Fitting

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

Brace Fitting

Thank you!!!

Q&A