20.50 Only OTS Solution to Patellofemoral Pain

Vague anterior knee pain is a very common patient complaint. It affects some 2.5 million Americans annually and is one of the largest and most challenging complaints physicians hear. Patellofemoral Pain Syndrome is now recognized to encompass a large disparate group of medical conditions that cause pain at the front of the knee. The patient profile is predominantly weighted women and young girls. The insurance

trend is moving towards off-the-shelf bracing.

Form Follows Flexion

The most common bracing solution to anterior knee pain is a soft sleeve. These use one of several buttress designs to put pressure on the patella. As the leg goes into extension, these buttresses exert pressure to keep the patella in the patellar groove. But patients are experiencing insufficient relief from the soft braces. Soft Braces do not provide the lateral strength

to resist the quad. Hinged soft knee braces provide greater lateral strength, but still not sufficient to resist the muscle group with patellofemoral problems. The biggest issue is the disrupted movement of the patella gliding into the femoral groove. In normal patellofemoral articulation, the patella is in contact with the femur between 20 and 50 degrees flexion.

As the only patellofemoral brace functioning at 20 – 50 degrees flexion, the 20.50 Patellofemoral Brace:

Improves patellofemoral tracking Controls patellar subluxation and dislocation

Traditional soft sleeve braces have little impact on the patella at the point in time where they could alter the tracking. Additionally, the brace must be rigid enough to act as a strong, stable foundation to counter the lateral force of the quadriceps. This requires a rigid brace and dynamic action that adapts to the increasing pressure. The rigid shell performance of the 20.50 Patellofemoral Brace counters the force of the quads and resists rotation.

Bledsoe is the only manufacturer making a rigid frame off-the-shelf patellofemoral brace that functions in flexion.

This is a doubly nice distinction for us as it is the only off-the-shelf brace on the market and an off-the-shelf brace can be stock and bill while a custom brace cannot. Our competitor’s are offering only custom rigid frames.

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Defining the Pain

Patellofemoral pain syndrome can be defined as retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint. It should be distinguished from chondromalacia, which is actual fraying and damage to the underlying patellar cartilage. Patients with patellofemoral pain syndrome have anterior knee pain that typically occurs with activity and often worsens when they are descending steps or hills. It can also be triggered by prolonged sitting. One or both knees can be affected.

The patella (kneecap) is the moveable bone on the front of the knee. The patella articulates with the patellofemoral groove in the femur. Several forces act on the patella to provide stability and keep it tracking properly.

This unique bone is wrapped inside a tendon that connects the large muscles on the front of the thigh, the quadriceps muscles, to the lower leg bone. The large quadriceps tendon together with the patella is called the quadriceps mechanism. Though we think of it as a single device, the quadriceps mechanism has two separate tendons, the quadriceps tendon on

top of the patella and the patellar tendon below the patella.

Tightening up the quadriceps muscles places a pull on the tendons of the quadriceps mechanism. This action causes the knee to straighten. The patella acts like a fulcrum to increase the force of the quadriceps muscles.

The underside of the patella is covered with articular cartilage, the smooth, slippery covering found on joint surfaces. This covering helps the patella glide (or track) in a special groove made by the thighbone, or femur. This groove is called the femoral groove.

Two muscles of the thigh attach to the patella and help control its position in the femoral groove as the leg straightens. These muscles are the Vastus Medialis Obliquus (VMO) and the Vastus Lateralis (VL). The VMO runs along the inside of the thigh, and the VL lies along the outside of the thigh. If the timing between these two muscles is off, the patella may be pulled off track.

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A common misconception is that the patella only moves in an up-and-down direction. In fact, it also tilts and rotates, so there are various points of contact between the undersurface of the patella and the femur.

Causes of Patellofemoral Pain Syndrome

Managing patellofemoral pain syndrome is a challenge, in part because of lack of consensus regarding its cause and treatment.

Overuse and overload of the patellofemoral joint Because bending the knee increases the pressure between the patella and its various points of contact with the femur, patellofemoral pain syndrome is often classified as an overuse injury. However, a more appropriate term may be "overload," because the syndrome can also affect inactive patients. Repeated weight-bearing impact may be a contributing factor, particularly in runners. Steps, hills and uneven surfaces tend to exacerbate patellofemoral pain. Once the syndrome has developed, even prolonged sitting can be painful ("movie-goer's sign") because of the extra pressure between the patella and the femur during knee flexion.

Biomechanical ProblemsPes Planus (Pronation). The terms "flat feet" and "foot pronation" are often used interchangeably. Technically speaking, foot pronation is a combination of eversion, dorsiflexion and abduction of the foot. This condition often occurs in patients who lack a supportive medial arch. Foot pronation causes a compensatory internal rotation of the tibia or femur (femoral anteversion) that upsets the patellofemoral mechanism. This is the premise behind using arch supports or custom orthotics in patients with patellofemoral pain.

Pes Cavus (High-Arched Foot, Supination). Compared with a normal foot, a high-arched foot provides less cushioning for the leg when it strikes the ground. This places more stress on the patellofemoral mechanism, particularly when a person is running. Proper footwear, such as running shoes with extra cushioning and an arch support can be helpful.

Q Angle. Although some investigators believe that a "large" Q angle is a predisposing factor for patellofemoral pain,

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Pes planus, or flat foot (left), in a nonweight-bearing state. Loss of the medial arch with weight-bearing (right) causes the ankle to "roll" medially. To compensate, the femur or tibia rotates internally, increasing valgus and stressing the patellofemoral mechanism. Arch supports can help with this problem.

Q angle. The relevance of this measurement in patients with patellofemoral pain syndrome has been questioned.

others question this claim. One study found similar Q angles in symptomatic and non-symptomatic patients.

Another study compared the symptomatic and asymptomatic legs in 40 patients with unilateral symptoms and found similar Q angles in each leg. Furthermore, "normal" Q angles vary from 10 to 22 degrees, depending on the study, and measurements of the Q angle in the same patient vary from physician to physician. Therefore, the physician should be wary of placing too much emphasis on such biomechanical "variants," as this can lead patients to believe that nothing can be done about their pain.

Muscular dysfunctionWeakness of the quadriceps muscles is the most often cited area of concern. Other issues include a muscle imbalance where the quadriceps actually pull the patella out of the patellar groove, weak quadriceps, hip muscles, calf muscles, hamstrings, or tight iliotibial bands.

Symptoms

Slipping SensationWhen people have patellofemoral problems, they sometimes report a sensation like the patella is slipping.

PainOthers report having pain around the front part of the knee or along the edges of the kneecap. Typically, people who have patellofemoral problems experience pain when walking down stairs or hills. Keeping the knee bent for long periods, as in sitting in a car or movie theater, may cause pain.

“Popcorn”The knee may grind, or there may be a crunching sound when squatting or going up and down stairs.

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Treatment Options Non-surgical TreatmentThe initial treatment for a patellar problem begins by:

Decreasing the inflammation in the knee Rest and anti-inflammatory medications Physical therapy, possibly with ice massage and ultrasound to limit pain

and swelling Bracing or taping the patella to prevent mal-tracking

Surgical TreatmentIf non-surgical treatments fail to improve the condition, surgery may be suggested.

Lateral ReleaseThe doctor will cut little slits in the lateral muscles to decrease the lateral pull.

Proximal RealighmentThe doctor will advance the Vastus Medialus Oblique (VMO) muscle over the patella to increase the medial pull.

Distal RealignmentThe doctor will detach the Patella Tuberosity (connecting part for the quad muscle and reattach the bone in an area they think will correct the Q angle.

Sometimes the doctor will do all three at once.

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The 20.50 Patellofemoral brace offers several innovations:

First rigid off-the-shelf patellofemoral brace on the market

Patello-Force strap promotes natural patella movement including tilt and rotation

Magnesium frame adds stable foundation for Patellofemoral as well as MCL and LCL support

Shortest brace in this market Made of high strength magnesium alloy

and weighs a mere 12 -13 ounces Crescent Finger Pad grips the patella to

control Medial Tilt, Patellar Baja and other forces

Corrects high Q-Angle lateral pull

The strapping has a unique look and function to: Effectively control mal-tracking Counter high Q-angle pull Allow appropriate movement on the knee including tilt and rotation

Due to the short frame, the brace sits above the calf muscle belly, unlike other braces in this market. Therefore, the tibial shell is one size smaller than the femoral shell in the standard black off-the-shelf version. The 20.50 is also available in a custom version.

Off-the-Shelf price is $ 399 Custom price is $ 599 Lcode: L1845 Lcode: L1846

Satisfies patella tracking add-on code L2800 (Custom) or L2795 (OTS).

Size Thigh Calf Left Right

XS34.3 – 40.6 cm13.5” -16.0”

27.9 – 31.7 cm11.0” – 12.5”

PF010101 PF010201

S40.6 – 47.6 cm16.0” – 18.75”

31.7 – 35.6 cm12.5” – 14.0”

PF010103 PF010203

M47.6 – 54.6 cm18.75” – 21.5”

35.6 – 39.4 cm14.0” – 15.5”

PF010105 PF010205

L54.6 – 61.6 cm21.5” – 24.25”

39.4 – 43.2 cm15.5” – 17.0”

PF010107 PF010207

XL61.6 – 68.6 cm24.25” – 27.0”

43.2 – 47.0 cm17.0” – 18.5”

PF010109 PF010209

XXL68.6 – 74.9 cm27.0” – 29.5”

47.0 – 50.8 cm18.5” – 20.0”

PF010111 PF010211

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Accessories

The replacement pad kit consists of: Femoral pad Tibial pad Regular strap pad Gripper strap pad Y-patella pad and air bladder (no pump) Patella buttress pad

  The replacement strap kit consists of the two regular straps and the two elastic straps.  The part numbers are:

 Size Left

XS PF041001

S PF041003

M PF041005

L PF041007

XL PF041009

XXL PF041011

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Size Left Right

XS PF040101 PF040201

S PF040103 PF040203

M PF040105 PF040205

L PF040107 PF040207

XL PF040109 PF040209

XXL PF040111 PF040211