FW: URGENT:Ruptured patella tendon replies
Paul E. Prusakowski
Description
Collection
Title:
FW: URGENT:Ruptured patella tendon replies
Creator:
Paul E. Prusakowski
Date:
11/6/2000
Text:
PATRICIA YOU MIGHT WANT TO CHECK WITH BECKER ON THE WEIGHT OF YOURPATIENT.
I WAS TOLD SOME YEARS AGO THAT THE HEAVIER THE PATIENT THELESS THE TRICK
KNEE IS ABLE TO KICKTHE FOOT FORWARD. I THINK THE JOINTWORKS BEST ON A
LIGHTER PATIENT BUT CHECK WITH THEM TO MAKE SURE.
ALLEN GULLIFER
Becker also makes a joint that can be limited in rom by moving a stop on
thedial, look thro the catalog and you will find it. I think it is
unrealisticto suspend this KO without going to the foot withan aFO, try the
control ofrotation with the use of an afo section. Doc might back off then
if that isincluded in arguement for use of afo besides suspensio, with ankle
jt orleafspring typre it is so light and practical as well.
Paul T. Webber
We have not had good success using the trickKnee Joints. Patients still
essentially ambulate with an extended knee as though it were locked.May be
more appropriate to use KAFO with drop locks. KO will probably migrate
south.Ralph W NObbe CPO
I am currently facing a similar dilemma. Pt is 18 y/o male, dx limb
girdle MD, weak quads. Same Rx as yours (but bilateral). I am currently
having Flex Tech fab KOs using the becker trick knee joint. hope to receive
soon and deliver next week. I have used this joint once before, taking
advantage of the extension assist--it worked well. Weight is certainly a
concern. I know that flex tech makes very light weight shells of carbon
fiber. They will only use about 4 of the uprights, so I don't think weight
will be a huge issue in this case. And I've never had suspension problems
with their products either--granted my pt. is very lean. I had a similar
Rx a few years ago. On that one I fabricated ant. poly shells and used a
regular becker drop lock joint. I hand filed the proximalmost tip of the
lower bar (the part that contacts the inside front of the drop lock when a
flexion force is applied) back at a 30 degree angle from the face. This did
function as desired--30 degrees of free end range motion (i.e., 30 degree
flexion stop) and drop locks to allow full flexion for sitting. The only
drawback was that is was noisy. I think you are right to be concerned
about suspension with your pt. Regardless of which joint you utilize, you
may want to consider using posterior shells. This way you can more easily
add a PLS AFO to the system if necessary. Hope this helps! Good luck.Troy
Fink, C.O.
Wally Motlock taught me a trick that I have used twice in similar
situations. Use a regular set of bilat. drop lock uprights, and grind away
30 degrees of motion from the inner anterior surface of the joint. In
essence, you are creating 30 degrees of flexion with the drop locks down,
and full range when the locks are up. It reminds me of the really old KAFOs
that come in with all that slop while the locks are down. I'm sure the folks
that make the joints are going to jump up and down about how that voids the
warranty, etc., but sometimes we must sacrifice for our art. I'd have to
lean towards a KAFO w/ a light leaf spring AFO as suspension instead of the
KO. I have no experience w/ the trick knee joint, but I've heard it is very
bulky.Steve Baum, CO
I have successfully treated two identical patients with a floor reaction
AFO. In both cases there was no problem with M/L stability at the knee. I
used a rear entry design with free tamarack joints and an anterior stop of
extra thickness of plastic. The patients liked them because there was no
restriction to kmee motion or ankle
planter flexion. On one of them I missed the dorsi stop angle but just came
back and welded more plastic on the stop. They continue to use them after
two years.
Terry Supan, CPO
I would not recommend using the model #1016 for the patient that you
describe. The stainless steel casting of that particular knee joint will not
take the load. It was not designed for the pathology your describe.
In the past, we have modified out model #1012 knee joint to accommodate a 0
to 30 degree range of motion. The posterior pin locking ring lock can be
used in a standard fashion for unlocking the knee for sitting.
If you look at the Becker catalog on page IIB-20 you will see a parts
schematic of the knee joint. The range of motion is made possible by
machining the lower upright part # 10. The locking sear on the top of the
male clevis is machined or ground away to allow the ring lock pin room to
move and allow the ROM you desire. The ring
lock pin is placed in the locked position. If the patient needs the stop,
the pin will engage the sear at 30 degrees of flexion or at the desired
range of motion stop that you desire. The flexion range for this
modification is 30 degrees or less.
Steve Prock in the north Dallas area was the first practitioner who worked
with me to devise this modification. He has utilized this modification
several times in the past four years, so there is some confidence in the
application.
If this meets your needs, you can call our Customer Sales Representative for
your area, Carol Kerney at 800 521-2192
Gary G. Bedard, CO, FAAOP
Clinical Marketing Manager
Becker Orthopedic Company
(650) 349-0752 direct office line
With regard to the pt. with the ruptured patella tendon, I
used this same Becker joint successfully on a similar case.
I used a KAFO and I suggest you do the same. The shape and
condition of your patient suggest the device would soon be
at her ankle if it was a K.O.. Unfortunately a Dr. chose to
have my KAFO modified into a K.O. and in a week the pt.
returned to us and we had to mount a prosthetic suspension
belt to keep the unit in its proper positioning.
Gene Solvnties L.CPO
You're right: the Tricknee joints are heavy. It will be difficult if not
impossible to suspend them without a foot component, unless you use a waist
belt. Sounds like that could be challenging too.
OTS has a new locking knee joint out called the Notchlock, I think. I
haven't actually seen it, but it looks a lot like the Steplock joint, I
think by the same manufacturer. I'm not sure if it has the features you
seek, but it's worth looking into. I think this joint is more sophisticated
than the Tricknee anyway. Good luck!
Naomi C. Matsui, CO(c)
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I WAS TOLD SOME YEARS AGO THAT THE HEAVIER THE PATIENT THELESS THE TRICK
KNEE IS ABLE TO KICKTHE FOOT FORWARD. I THINK THE JOINTWORKS BEST ON A
LIGHTER PATIENT BUT CHECK WITH THEM TO MAKE SURE.
ALLEN GULLIFER
Becker also makes a joint that can be limited in rom by moving a stop on
thedial, look thro the catalog and you will find it. I think it is
unrealisticto suspend this KO without going to the foot withan aFO, try the
control ofrotation with the use of an afo section. Doc might back off then
if that isincluded in arguement for use of afo besides suspensio, with ankle
jt orleafspring typre it is so light and practical as well.
Paul T. Webber
We have not had good success using the trickKnee Joints. Patients still
essentially ambulate with an extended knee as though it were locked.May be
more appropriate to use KAFO with drop locks. KO will probably migrate
south.Ralph W NObbe CPO
I am currently facing a similar dilemma. Pt is 18 y/o male, dx limb
girdle MD, weak quads. Same Rx as yours (but bilateral). I am currently
having Flex Tech fab KOs using the becker trick knee joint. hope to receive
soon and deliver next week. I have used this joint once before, taking
advantage of the extension assist--it worked well. Weight is certainly a
concern. I know that flex tech makes very light weight shells of carbon
fiber. They will only use about 4 of the uprights, so I don't think weight
will be a huge issue in this case. And I've never had suspension problems
with their products either--granted my pt. is very lean. I had a similar
Rx a few years ago. On that one I fabricated ant. poly shells and used a
regular becker drop lock joint. I hand filed the proximalmost tip of the
lower bar (the part that contacts the inside front of the drop lock when a
flexion force is applied) back at a 30 degree angle from the face. This did
function as desired--30 degrees of free end range motion (i.e., 30 degree
flexion stop) and drop locks to allow full flexion for sitting. The only
drawback was that is was noisy. I think you are right to be concerned
about suspension with your pt. Regardless of which joint you utilize, you
may want to consider using posterior shells. This way you can more easily
add a PLS AFO to the system if necessary. Hope this helps! Good luck.Troy
Fink, C.O.
Wally Motlock taught me a trick that I have used twice in similar
situations. Use a regular set of bilat. drop lock uprights, and grind away
30 degrees of motion from the inner anterior surface of the joint. In
essence, you are creating 30 degrees of flexion with the drop locks down,
and full range when the locks are up. It reminds me of the really old KAFOs
that come in with all that slop while the locks are down. I'm sure the folks
that make the joints are going to jump up and down about how that voids the
warranty, etc., but sometimes we must sacrifice for our art. I'd have to
lean towards a KAFO w/ a light leaf spring AFO as suspension instead of the
KO. I have no experience w/ the trick knee joint, but I've heard it is very
bulky.Steve Baum, CO
I have successfully treated two identical patients with a floor reaction
AFO. In both cases there was no problem with M/L stability at the knee. I
used a rear entry design with free tamarack joints and an anterior stop of
extra thickness of plastic. The patients liked them because there was no
restriction to kmee motion or ankle
planter flexion. On one of them I missed the dorsi stop angle but just came
back and welded more plastic on the stop. They continue to use them after
two years.
Terry Supan, CPO
I would not recommend using the model #1016 for the patient that you
describe. The stainless steel casting of that particular knee joint will not
take the load. It was not designed for the pathology your describe.
In the past, we have modified out model #1012 knee joint to accommodate a 0
to 30 degree range of motion. The posterior pin locking ring lock can be
used in a standard fashion for unlocking the knee for sitting.
If you look at the Becker catalog on page IIB-20 you will see a parts
schematic of the knee joint. The range of motion is made possible by
machining the lower upright part # 10. The locking sear on the top of the
male clevis is machined or ground away to allow the ring lock pin room to
move and allow the ROM you desire. The ring
lock pin is placed in the locked position. If the patient needs the stop,
the pin will engage the sear at 30 degrees of flexion or at the desired
range of motion stop that you desire. The flexion range for this
modification is 30 degrees or less.
Steve Prock in the north Dallas area was the first practitioner who worked
with me to devise this modification. He has utilized this modification
several times in the past four years, so there is some confidence in the
application.
If this meets your needs, you can call our Customer Sales Representative for
your area, Carol Kerney at 800 521-2192
Gary G. Bedard, CO, FAAOP
Clinical Marketing Manager
Becker Orthopedic Company
(650) 349-0752 direct office line
With regard to the pt. with the ruptured patella tendon, I
used this same Becker joint successfully on a similar case.
I used a KAFO and I suggest you do the same. The shape and
condition of your patient suggest the device would soon be
at her ankle if it was a K.O.. Unfortunately a Dr. chose to
have my KAFO modified into a K.O. and in a week the pt.
returned to us and we had to mount a prosthetic suspension
belt to keep the unit in its proper positioning.
Gene Solvnties L.CPO
You're right: the Tricknee joints are heavy. It will be difficult if not
impossible to suspend them without a foot component, unless you use a waist
belt. Sounds like that could be challenging too.
OTS has a new locking knee joint out called the Notchlock, I think. I
haven't actually seen it, but it looks a lot like the Steplock joint, I
think by the same manufacturer. I'm not sure if it has the features you
seek, but it's worth looking into. I think this joint is more sophisticated
than the Tricknee anyway. Good luck!
Naomi C. Matsui, CO(c)
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list.
Citation
Paul E. Prusakowski, “FW: URGENT:Ruptured patella tendon replies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/215313.
