1. Competitor Products

2. ACL Injury Forces Which May Cause Injury / \
/ \
70% Non contact % contact
Deceleration + cutting, Lateral Blow
pivoting, Anterior Blow
side stepping, (Hyperextension)
Awkward landings

3. Ligament Injury
Anterior tibial translation and internal torque loads can injure the ACL or stretch out a graft.

4. Ligament Injury
Increased medial joint opening during lateral blows, which occur in contact sports, can injure both the MCL and ACL.

5. Ligament Injury
Hyperextension of the knee if knee is straightened more than 10º beyond the fully extended position

6. Ligament Injury
Small knee flexion angles at initial contact during landing tasks may contribute to “non-contact” ACL injuries.

7. Competitor Products

8. Active Braces DJO ACL/PCL LIGAMENT BRACES ACTIVE BRACES
! 4 POINT DESIGN !
Actively addresses instability at all times

9. Active vs. Passive Braces
The tibial control component encompasses the tibia and parallels the tibial crest to help inhibit anterior and pivotal tibial excursion caused by ACL laxity. The non-elastic upper cruciate strap provides an opposing force on the femur to help stabilize the knee.
A six-point system helps provide excellent medial and lateral support. The rigid graphite frame's lateral arms, condylar support at the joint and non-elastic Velcro straps help inhibit medial and lateral instability. Blue arrows indicate support opposing valgus forces; white arrows indicate support opposing varus forces.

10. Competitive Testing
Mechanical Evaluation of “Off the Shelf” and Custom Knee Braces: Parameters of Stability and Component Failure
Mahar A, Oka R, Odell T, Wedemeyer M
Department of Orthopedics
Children’s Hospital, San Diego
University of California, San Diego

11. Competitive Testing Methods
11 braces (n=3 of each) from 6 manufacturers
All braces were new, representing those most currently available on the market
Manufacturer
Model
Custom/OTS
DonJoy
Armor
OTS
4titude FP
Defiance
Custom
Breg
Fusion
Custom=OTS*
X2K
Innovation Sports
Edge
CTi2
Townsend
Rebel
Premier
Medi M4
Generation II
3DX
*Vendors report identical biomechanics between Custom and OTS

12. Competitive Testing
Methods
Varus stiffness
Valgus stiffness

13. Competitive Testing Methods Strap tab stiffness
Strap tab failure strength

14. Competitive Testing Methods Hyperextension stiffness
Hyperextension failure strength

15. Competitive Testing
Results – Valgus / Varus Stiffness
NEW

16. Competitive Testing
Results – Strap Tab Stiffness
NEW

17. Competitive Testing
Results – Hyperextension Stiffness
NEW
NEW

18. Competitive Testing Results
Composite Scores for Six Biomechanical Parameters of Stability and Component Failure
NEW

19. Competitive Testing
Conclusion

20. Extra ACL Protection
FourcePoint Hinge

21. FourcePoint Why is added ACL protection needed?
>75% of all ACL ruptures are non-contact
Women are up to 10X more likely to suffer a non-contact ACL injury than men
Non-contact ACL injuries frequently occur during stop-jump activities
Forward
Vertical
Backward

22. FourcePoint What puts ACL at risk?
Joint angles less than 600 (Beynnon; Markolf) p
p = 00

23. FourcePoint How does it perform clinically?
Immediate Effects of a Knee Brace With a
Constraint to Knee Extension on Knee Kinematics and Ground Reaction Forces in a Stop-Jump Task
Bing Yu,*† PhD, Daniel Herman,† MS, William Lu,‡ PhD,
Donald T. Kirkendall,† PhD, and William E. Garrett,† MD, PhD
From the †University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,
and the ‡University of Hong Kong, Hong Kong
No author or related institution has received financial benefit from research in this study.
The American Journal of Sports Medicine, Vol. 32, No. 5
DOI: /
© 2004 American Orthopedic Society for Sports Medicine

24. FourcePoint Objective
Determine the effects of a specially designed knee brace on the lower extremity kinematics & kinetics of athletes in a stop-jump task in which non-contact ACL injuries frequently occur

25. FourcePoint Study Design
12 male & 12 female recreational athletes years old
3-D coordinates of reflective markers placed on selected critical body landmarks
5 trials with & without the new brace for each subject

26. FourcePoint
Results
Brace wearers flexion angle increased ~5o

27. FourcePoint Does 5o flexion angle increase matter?
The anterior shear force applied on the tibia will be reduced by 9% for females & 13% for males (Nuley et al., 2002)
The decrease in anterior shear force on the tibia will substantially reduce the load on the ACL

28. Competition

29. Competitor Braces – Ossur
CTi custom
CTi OTS
Edge
Morph (discontinued)
C180

30. Ossur Advantages Disadvantages Well known ‘Accutrac’ hinges
Extreme sports market
Internationally recognised brand
Customer service
Employ Orthotists to fit and advise
Disadvantages
‘Passive’ design
‘Bulky’ frame
Do not guarantee the brace will protect!
Slippage
Causes damage to bike frame
Expensive
Charge for measuring

31. Competitor Braces - Breg
Fusion
Fusion womens
Fusion XT
X2K
X2K high performance
X2K womens
X2K unlimited
Compact X2K
X2K - PTO

32. Breg Advantages Disadvantages Surgeon relationship Cost effective
‘Diamond’ design on X2K
‘Proform’ technology (sleek, lightweight, conforms to the leg)
Fusion – protection from lateral impact
Fusion significantly increased market share – 215 college teams now using the brace
Patient compliance - comfort
Disadvantages
‘Passive’ design
Only for contact injuries
Contradictory message between designs
Poor quality
Contact injuries occur in less than 30% of injuries
Weaker than DJO braces in competitive testing study

33. Competitor Braces - Medi
Standard
Short

34. Medi Advantages Disadvantages Four point principal brace
Low profile, light weight
Smart extension stop kit
Lower priced than DJO
Customer relationships built through hosiery range
Disadvantages
Poor quality materials
Hyper extends when extension stop removed
No significant research studies
Weakest brace in competitive bracing study
Off the shelf only

35. Competitor Braces - Bledsoe
Axiom OTS
Axiom Sport
Ultimate CI

36. Bledsoe Advantages Disadvantages
Robust braces, option for reinforced brace
‘STAR’ programme
Disadvantages
Passive design
Bulky and heavy
No significant research
AOP scan file required for custom brace

37. Conclusion

38. Protection With A Brace??
DJO v’s Competition

39. Ligament Injury
Anterior tibial translation and internal torque loads can injure the ACL or stretch out a graft.

40. Anterior Tibial Translation Protection
4 point braces only
All DJO Braces
Medi M4
Medi Premier Lite

41. Ligament Injury
Increased medial joint opening during lateral blows, which occur in contact sports, can injure both the MCL and ACL.

42. Lateral Blow Protection
All DJO braces
Ossur (CTi)
Bregg
Bledsoe

43. Ligament Injury
Hyperextension of the knee if knee is straightened more than 10º beyond the fully extended position

44. Hyperextension Protection
All DJO braces
Ossur (CTi)
Bregg
Bledsoe

45. Ligament Injury
Small knee flexion angles at initial contact during landing tasks may contribute to “non-contact” ACL injuries.

46. Small Knee Flexion Angle Protection
Fourcepoint Hinge Only!!

47. Tibial Translation
Lateral Blow
Hyper- extension
Small Flexion Angle
DJO
Ossur
Bregg
Medi
Bledsoe

48. DJO Braces are the ONLY Braces to give all round ligament protection