L6: Orthotics for Knee INstability Flashcards
Prescribing/Recommending knee orthotics:
Understand these things:
- knee mechanics, goals of pt*,
- ***mechanical properties brace affords
Categories of knee orthoses→ based on desired goals, sx protocols, pt and PT
3 categories: ALL
- Rehab knee orthosis (RKO)
- dial lock, max restrict, protects sx site
- Functional knee orthosis (FKO)
- Return to Sport brace
-
Prophylactic knee orthosis
- Just an FKO worn to prevent/limit injuries***
This knee orthosis has a dial lock, MAX restriction, protects sx site
RKO
This knee orthosis is a Return to Sport brace
FKO
This knee orthosis is just an FKO BUT worn prophylactically to prevent/limit injuries
PKO
Rehab Knee Orthosis (RKO)
used for/design
- Post-op/early rehab
- Controls excessive loading on healing tissues and controls knee motion***
- Looooonger vs FKO/PKO for greater control/comfort
- ***Dial lock one!!!
RKOs
More on design+Post-Sx progressions/protocols
- Adjustable (dial lock)→ for free AROM incremental inc’s
-
Post-sx progression/protocols:
- ACLs→ 0-90 free motion (NWB) 0-7 days (full EXT) PROM
- In WB→ locked first 2-4wks or until good quad control and hold
- AAROM→ 0-130 by 6wks
- FULL AROM by 10-12wks
RKOs
Effective rehab braces have these qualities:
- Adjustable→ for edema or atrophy, for standing/WB, MD protocols and sitting
- Comfy, easy to don/doff
FKO brand to know
DonJoy
More dynamic brace vs RKO
FKO
FKOs
Features
- Lt wt, rigid
- Adj. velcro→ 4-point stabilizing force (same concept as 3-point)
- Some polycentric→ mimic slide/glide, some w/ flex control OR ext assist
- More dynamic vs RKO
Functional Knee Orthosis (FKO)
Components/Stabilizing forces broken down
*know where forces are located
- Posterior force over anterior prox. thigh
- Anterior force on distal posterior femur
- Posterior force @ prox. anterior tibia
- Anterior force @ midshaft of posterior tibia
FKOs
ACL insufficiency
- Prevents forward translation of the tibia on femur (or posterior translation of femur on tib)
- bc this is ACLs function!!!
FKOs
OA (esp Medial knee compartment)
aka Varus deformity corrected by valgus force brace
- Valgus orthoses→ Dec pain by unloading knee jt during stance phase w/ adjustable tension straps crossing Lateral knee joint
FKOs
PTFJ dysf/pain
- Neoprene sleeve over knee w/ opening over patella and “J” or semicircle buttress @ lateral patella
- Goal→ guides patella in intracondylar groove
- Design→ control undesirable, excessive lateral mvmt of patella
3 Conditions we talked about for use of FKO brace
ACLs
OA
PTFJ pain
More FKO pics
ACL braces prevent anterior translation of tibia on femur
PKO brace
P is for Prophylactic
SO when you see PKO brace also think…..
PREVENTATIVE!!!
PKO BRACE
- Prevent injury→ protect soft tissue restraints of knee
- Worn by athletes exposed to lateral impacts (think about how brace set (medial protection)
- NOT preferred for skill pos’s (RBs, WRs)
- passive brace
PKOs
Protection
- Protects→ MEDIAL knee jt structures→ MCL, MM and internal knee ligs (ACL, PCL)
-
Research→ marginal benefits
- no conclusive evidence for prevention injuries
- too many variables to control**
FKOs
Research for ACLs
- incd afferent input to knee mm’s
- slightly more energy expend.
- impaired blood flow to distal thigh and leg straps→ more foot/ankle injuries
- No diff in ant. tibial translation w/ hop test
- Placebo, ACL brace, no brace→ no diff in mm function
FKOs
Research for MCLs:
- 1 study w/ sig reduction in MCL knee injuries
- “more secure”
- afferent input
BASICALLY w/ these braces just know
RKO vs FKO vs PKO
- RKO→ post-op, follows protocols, incremental adjustments, protects sx site
-
FKO→ ACL, OA, PTFJ pain/dysf
- protects medial compartment knee, valgus force to accommodate varus deforms
- PKO→ Preventative, just an FKO but worn to prevent injury
