Knee Brace Challenge
Rajiv Kalsi
Description
Collection
Title:
Knee Brace Challenge
Creator:
Rajiv Kalsi
Date:
4/28/2021
Text:
Hi everyone. Thank you to those who responded to the knee brace challenge question, about a person who fell at home and suffered an MCL and ACL injury, leaving the knee quite lax. Her doctor has recommended that she not bear any weight on the leg to stand. This woman weighs over 400 lbs and has much flaccid soft tissue, which makes even assessment of the knee a challenge. Unfortunately, we do not think that in our case we can successfully stabilize the knee due to difficulty locating anatomy, and if we could get something tight enough to control movement it would probably cause skin issues. I have listed below some of the responses below:
I have fit a few people this weight with the donjoy rebel lock with extension assist. The frame is easy to bend to add to the m/l. Adding velcro to the front of the frame so they dont have to fold the strap back under them has increased independent donning. Good luck!
It is incredibly difficult to brace with these aspects---by the time you have a brace (ie a full contact Thuasne/Townsend) brace, or a Breg post op ROM KO for example- becomes the patient and skin tolerance of a brace being between the legs- not to mention maintaining simple ideas of fit. If doctor does not want her to bear weight---what are the goals of bracing for this patient--and are they likely to stay off the leg?
I fit a patient like this years ago, we ended up having to go with a KAFO, the suspension with the KO was a nightmare. She had so much adipose tissue nothing would stay in place
had young lady that weighed 420lb. We made her custom townsend ko with lateral strut and it worked well. You MUST go with the street to prevent distal migration so, technically, it's a KAFO. She then had bariatric done and lost 200lb. We ended making a 2nd KAFO for changed anatomy. Both worked well.
Townsend Design is probably the best source for custom knee braces for
patients over 350 lbs
In my opinion from past experience not braceable because you couldn't get enough tissue compression to provide adequate immobilization and support anyway unless you did a KAFO for suspension and basically locked her down which I doubt you will get reimbursement.
Not easy but has to be made as a KAFO and casting is done with high compression to move the tissues a little to wear you want them and following requires compression to cast where you want to create for hold into the adipose tissue. This would normally be along the femur medial and lateral. Everyone is a little variant how that weight sits. The final product would have to be with a internal full leather molded gauntlet with lace closure. This only works if compression is done prior with roles of plastic to form the limb. Yes if lucky can be the plaster can be shaved but truly the most experience are gambling with that one. Either way it's a gamble. Now they will probably also have to wear a good thigh high compression garment to also aid in fit.
If MD will document she is ambulatory or has potential with the brace- I would do a custom KAFO with a lockable knee. A knee brace will not work for several reasons in my opinion.
I have a similar situation right now here in Lethbridge, AB but my patient has OA. The soft tissue is a major issue. I am planning on trying a Custom Bauerfeind GenuTrain S. It could work in your situation as well. They will custom make the knitted sleeve portion based on the patients measurements.
Rajiv Kalsi, C.O.(c)
Certified Orthotist, Prosthetics/Orthotics Service
Orthésiste Certifié, Service de prothèses et d'orthèses
The Ottawa Hospital Rehabilitation Centre
Centre de réadaptation de l’Hôpital d’Ottawa
505, ch. Smyth Road, Ottawa ON K1H 8M2
T: 613-737-7350, 75314 | F: 613-523-1571
<Email Address Redacted>
[cid:10b00455-31d4-4ab3-9caa-b9e25f6514f4]
[cid:96b7d5b2-2d8a-4b0e-a423-d88d6be04c51][cid:eb1dacb4-808e-4fda-a4e3-a2cac32d9e78][cid:295990ac-48a1-41cd-9ac2-cf900ccc46c9]
[cid:2c5bf52c-a4f0-4f58-90bf-9c49ce1f9403]
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I have fit a few people this weight with the donjoy rebel lock with extension assist. The frame is easy to bend to add to the m/l. Adding velcro to the front of the frame so they dont have to fold the strap back under them has increased independent donning. Good luck!
It is incredibly difficult to brace with these aspects---by the time you have a brace (ie a full contact Thuasne/Townsend) brace, or a Breg post op ROM KO for example- becomes the patient and skin tolerance of a brace being between the legs- not to mention maintaining simple ideas of fit. If doctor does not want her to bear weight---what are the goals of bracing for this patient--and are they likely to stay off the leg?
I fit a patient like this years ago, we ended up having to go with a KAFO, the suspension with the KO was a nightmare. She had so much adipose tissue nothing would stay in place
had young lady that weighed 420lb. We made her custom townsend ko with lateral strut and it worked well. You MUST go with the street to prevent distal migration so, technically, it's a KAFO. She then had bariatric done and lost 200lb. We ended making a 2nd KAFO for changed anatomy. Both worked well.
Townsend Design is probably the best source for custom knee braces for
patients over 350 lbs
In my opinion from past experience not braceable because you couldn't get enough tissue compression to provide adequate immobilization and support anyway unless you did a KAFO for suspension and basically locked her down which I doubt you will get reimbursement.
Not easy but has to be made as a KAFO and casting is done with high compression to move the tissues a little to wear you want them and following requires compression to cast where you want to create for hold into the adipose tissue. This would normally be along the femur medial and lateral. Everyone is a little variant how that weight sits. The final product would have to be with a internal full leather molded gauntlet with lace closure. This only works if compression is done prior with roles of plastic to form the limb. Yes if lucky can be the plaster can be shaved but truly the most experience are gambling with that one. Either way it's a gamble. Now they will probably also have to wear a good thigh high compression garment to also aid in fit.
If MD will document she is ambulatory or has potential with the brace- I would do a custom KAFO with a lockable knee. A knee brace will not work for several reasons in my opinion.
I have a similar situation right now here in Lethbridge, AB but my patient has OA. The soft tissue is a major issue. I am planning on trying a Custom Bauerfeind GenuTrain S. It could work in your situation as well. They will custom make the knitted sleeve portion based on the patients measurements.
Rajiv Kalsi, C.O.(c)
Certified Orthotist, Prosthetics/Orthotics Service
Orthésiste Certifié, Service de prothèses et d'orthèses
The Ottawa Hospital Rehabilitation Centre
Centre de réadaptation de l’Hôpital d’Ottawa
505, ch. Smyth Road, Ottawa ON K1H 8M2
T: 613-737-7350, 75314 | F: 613-523-1571
<Email Address Redacted>
[cid:10b00455-31d4-4ab3-9caa-b9e25f6514f4]
[cid:96b7d5b2-2d8a-4b0e-a423-d88d6be04c51][cid:eb1dacb4-808e-4fda-a4e3-a2cac32d9e78][cid:295990ac-48a1-41cd-9ac2-cf900ccc46c9]
[cid:2c5bf52c-a4f0-4f58-90bf-9c49ce1f9403]
________________________________
Confidentiality Statement - The contents of this e-mail, including its attachment, are intended for the exclusive use of the recipient and may contain confidential or privileged information. If you are not the intended recipient, you are strictly prohibited from reading, using, disclosing, copying, or distributing this e-mail or any of its contents. If you received this e-mail in error, please notify the sender by reply e-mail immediately or the Information and Privacy Office ( <Email Address Redacted> ) and permanently delete this e-mail and its attachments, along with any copies thereof. Thank you.
Avis de confidentialité – Ce courriel, y compris ses pièces jointes, s’adresse au destinataire uniquement et pourrait contenir des renseignements confidentiels. Si vous n’êtes pas le bon destinataire, il est strictement interdit de lire, d’utiliser, de divulguer, de copier ou de diffuser ce courriel ou son contenu, en partie ou en entier. Si vous avez reçu ce courriel par erreur, veuillez en informer immédiatement l’expéditeur ou le bureau de la protection de la vie privée et de l’information ( <Email Address Redacted> ), puis effacez le courriel ainsi que les pièces jointes et toute autre copie. Merci.
________________________________
Citation
Rajiv Kalsi, “Knee Brace Challenge,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/255476.
