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

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