Knee Extension Orthosis - Summary of replies - Part 1

Knee Extension Orthosis - Summary of replies - Part 1

Mark Raabe

7/18/2001

Fellow OandPers,
Please find following the responses Part 1 to the original question...
> Dear Colleagues,
> Have received a Rx for a knee orthosis with extension assist for a male
with
> removal of necrotic patella. Have been told that there is no extension
> mechanism of the knee left. Doctor wants an orthosis that will provide
> extension and stability during gait without being locked...ie. Allowing
knee
> flexion during gait! I am unaware of a suitable functional knee orthosis
or
> joint that would accomplish this. Does anyone know of possible solutions??
I
> know there has been numerous inquiries regarding a weight activated
locking
> joint on this server, have we discovered such an animal? And if so what
are
> people's experiences of it?
Most mentioned the Otto Bock 17B3 offset joints with extension
rubbers,(17Y35), with mention of the Scott Extension Orthosis as well (maybe
a bit bulky), but what I think I will try initially is a GRAFO - by
utilising the ToeOFF orthosis I think we will be able to ascertain if this
approach will be successful for our patient/client. The replies are
separated by blank line...

Thought about a GRAFO? or similar (ant trim AFO). Will prevent/restrict
uncontrolled knee flexion in stance and allow flexion during swing.The
other thought is post offset joints, but I have never been game enough
to actually use them as a hit/miss exercise.

Becker sell the Scott knee extension assist, I have used these and they
work
well.

A knee extension joint was developed at OTS and is marketed by Becker as the
Model 1016. If that has been d/c'd, you can fashion your own with a section
of surgical tubing that spans the joint and is fastened on the AK & BK
uprights.

we were just talking about this today in relation to polio patients and all
I can say is good luck. We talked about being able to attach an S'N'S unit
to the lateral upright of the caliper, assuming of course that you had the
hip power to drive it. Or an electronic one which uses foot switches to
control the knee but does such a monster exists? Maybe you could make a name
for yourself by devising such a thing. The patient you talk about has had
his patella removed? then from what I remember that leads to about only 30%
of quads power due to loss of the fulcrum. Would it be appropriate for
intensive PT if he is young and could buildup some strenght? Doesn't your ol
mates at bocky make a knee joint with rubbers for ext assist? I've seen them
somewhere but they look pretty weak and wanky.

Have you considered using an Ultraflex joint or orthosis? They sell their
joints individually if you were to make the brace in-house. The joint is
primarily used for resisting contractures, but the resistance is variable
and may be a thought for this application. There is also the option for
setting range of motion in the joint, which may be useful to the patient for
long periods of walking (can lock it to 0-30 degress) or standing (can lock
it to 0-10 maybe). Of course, that would depend on compliance of patient
and whether you felt he could adjust these ROMs. Otherwise, it could just
be free with the spring resistance. Nice joints; not too bulky for the
power they are capable of. They can fax you info on the joints. Their
phone: 800-220-6670

Call Scott Orthotic Labs, They have a couple of different models of K.O.'s
with extension assist, the SKO-437, and the SKO-438. One with polycentric
free knee joints, and one with drop locks with a ball retainer. They work
well, utilizing surgical tubing, the tension on the tubing can be increased
to allow greater extension assist, and it runs through a midsection piece
they fabricate. They have pre-fab sizing, and do custom to cast. Tell them
I sent you there, hope this helps sounds like exactly what your looking for.
I have used it on a couple of people with no to fair quadricep strength.

The trick knee joint will allow about 20 degrees of assisted knee flexion
during gait (but it is a locking joint). When new they work reasonably
well, but durability is an issue--particularly with large/active patients--I
believe that most of the major distributors carry them.

I know of a knee joint called Trick Knee, produced / distributed here in
the UK by either Otto Bock or Masser.
Hope this helps.

Check Otto Bock. They used to have an extension mechanism for their KAFO
uprights.

i know of 3 systems, the UTX, ultraflex system and a company in france make
an orthosis called the CDO

floor reaction AFO, or we sometimes use the CAMP toe off brace, email me if
you want to know any more info about either

Bock ex assist kafo 20 mm offset

Jane Marlor here...you may be able to obtain enough stability with a Becker
Posterior offset knee joint, it has an extension moment that stops flexion.

check out otto bock knee joints they are offset & have extension assist
rubber bands

You might want to look at Becker's Trick Knee joints. They provide an
adjustable extension moment while allowing flexion. They also come with
drop locks if needed for positive locking. I have used them very
successfully for patients/clients with polio/post polio syndrome but they
(the patients/clients) were relatively small and lightweight.

Replies are continued in part 2