20.50 Only OTS Solution to Patellofemoral PainVague anterior knee pain is a very common patient complaint. It affects some 2.5million Americans annually and is one of the largest and most challenging complaintsphysicians hear. Patellofemoral Pain Syndrome is now recognized to encompass alarge 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 strengthto resist the quad. Hinged soft knee braces provide greater lateral strength, but still notsufficient to resist the muscle group with patellofemoral problems. The biggest issue isthe disrupted movement of the patella gliding into the femoral groove. In normalpatellofemoral articulation, the patella is in contact with the femur between 20 and 50degrees flexion.As the only patellofemoral brace functioning at 20 – 50 degrees flexion, the 20.50Patellofemoral Brace: Improves patellofemoral tracking Controls patellar subluxation and dislocationTraditional soft sleeve braces have little impact on the patella at the point in time wherethey could alter the tracking. Additionally, the brace must be rigid enough to act as astrong, stable foundation to counter the lateral force of the quadriceps. This requires arigid brace and dynamic action that adapts to the increasing pressure. The rigid shellperformance of the 20.50 Patellofemoral Brace counters the force of the quads andresists 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 marketand an off-the-shelf brace can be stock and bill while a custom brace cannot. Ourcompetitor’s are offering only custom rigid frames. Page 1 of 7
Defining the PainPatellofemoral pain syndrome can be defined as retropatellar or peripatellar painresulting from physical and biochemical changes in the patellofemoral joint. It shouldbe distinguished from chondromalacia, which is actual fraying and damage to theunderlying patellar cartilage. Patients with patellofemoral pain syndrome have anteriorknee pain that typically occurs with activity and often worsens when they aredescending steps or hills. It can also be triggered by prolonged sitting. One or bothknees can be affected.The patella (kneecap) is the moveable bone on the front of the knee. The patellaarticulates with the patellofemoral groove in the femur. Several forces act on thepatella 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 topof the patella and the patellar tendon below the patella.Tightening up the quadriceps muscles places a pull on the tendons of the quadricepsmechanism. This action causes the knee tostraighten. The patella acts like a fulcrum toincrease the force of the quadriceps muscles.The underside of the patella is covered witharticular cartilage, the smooth, slippery coveringfound on joint surfaces. This covering helps thepatella glide (or track) in a special groove made bythe thighbone, or femur. This groove is called thefemoral groove.Two muscles of the thigh attach to the patella andhelp control its position in the femoral groove asthe leg straightens. These muscles are the VastusMedialis 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 thetiming between these two muscles is off, the patellamay be pulled off track. Page 2 of 7
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 theundersurface of the patella and the femur. Causes of Patellofemoral Pain SyndromeManaging patellofemoral pain syndrome is a challenge, in part because of lack ofconsensus regarding its cause and treatment.Overuse and overload of the patellofemoral jointBecause bending the knee increases the pressure between the patella and its variouspoints of contact with the femur, patellofemoral pain syndrome is often classified as anoveruse injury. However, a more appropriate term may be "overload," because thesyndrome can also affect inactive patients. Repeated weight-bearing impact may be acontributing factor, particularly in runners. Steps, hills and uneven surfaces tend toexacerbate patellofemoral pain. Once the syndrome has developed, even prolongedsitting can be painful ("movie-goers sign") because of the extra pressure between thepatella and the femur during knee flexion.Biomechanical ProblemsPes Planus (Pronation). Theterms "flat feet" and "footpronation" are often usedinterchangeably. Technicallyspeaking, foot pronation is acombination of eversion,dorsiflexion and abduction of thefoot. This condition often occursin patients who lack a supportive Pes planus, or flat foot (left), in a nonweight-bearing state.medial arch. Foot pronation Loss of the medial arch with weight-bearing (right) causes the ankle to "roll" medially. To compensate, the femur orcauses a compensatory internal tibia rotates internally, increasing valgus and stressing therotation of the tibia or femur patellofemoral mechanism. Arch supports can help with(femoral anteversion) that upsets this problem.the patellofemoral mechanism. This is the premise behindusing arch supports or custom orthotics in patients withpatellofemoral pain.Pes Cavus (High-Arched Foot, Supination). Compared witha normal foot, a high-arched foot provides less cushioningfor the leg when it strikes the ground. This places morestress on the patellofemoral mechanism, particularly when aperson is running. Proper footwear, such as running shoeswith 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, Q angle. The relevance of this measurement in patients with Page 3 of 7 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 withunilateral symptoms and found similar Q angles in each leg. Furthermore, "normal" Qangles vary from 10 to 22 degrees, depending on the study, and measurements of the Qangle in the same patient vary from physician to physician. Therefore, the physicianshould be wary of placing too much emphasis on such biomechanical "variants," as thiscan 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. Otherissues include a muscle imbalance where the quadriceps actually pull the patella out ofthe patellar groove, weak quadriceps, hip muscles, calf muscles, hamstrings, or tightiliotibial bands.SymptomsSlipping SensationWhen people have patellofemoral problems, they sometimes report a sensation like thepatella is slipping.PainOthers report having pain around the front part of the knee or along the edges of thekneecap. Typically, people who have patellofemoral problems experience pain whenwalking down stairs or hills. Keeping the knee bent for long periods, as in sitting in acar or movie theater, may cause pain.“Popcorn”The knee may grind, or there may be a crunching sound when squatting or going upand down stairs. Page 4 of 7
Treatment OptionsNon-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-trackingSurgical TreatmentIf non-surgical treatments fail to improve the condition, surgery may be suggested. Lateral Release The doctor will cut little slits in the lateral muscles to decrease the lateral pull. Proximal Realighment The doctor will advance the Vastus Medialus Oblique (VMO) muscle over the patella to increase the medial pull. Distal Realignment The 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. Page 5 of 7
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 pullThe 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 rotationDue to the short frame, the brace sits above the calf muscle belly, unlike other braces in thismarket. Therefore, the tibial shell is one size smaller than the femoral shell in the standardblack off-the-shelf version. The 20.50 is also available in a custom version.Off-the-Shelf price is $ 399 Custom price is $ 599Lcode: L1845 Lcode: L1846Satisfies patella tracking add-on code L2800 (Custom) or L2795 (OTS).Size Thigh Calf Left Right 34.3 – 40.6 cm 27.9 – 31.7 cm XS PF010101 PF010201 13.5” -16.0” 11.0” – 12.5” 40.6 – 47.6 cm 31.7 – 35.6 cm S PF010103 PF010203 16.0” – 18.75” 12.5” – 14.0” 47.6 – 54.6 cm 35.6 – 39.4 cm M PF010105 PF010205 18.75” – 21.5” 14.0” – 15.5” 54.6 – 61.6 cm 39.4 – 43.2 cm L PF010107 PF010207 21.5” – 24.25” 15.5” – 17.0” 61.6 – 68.6 cm 43.2 – 47.0 cm XL PF010109 PF010209 24.25” – 27.0” 17.0” – 18.5” 68.6 – 74.9 cm 47.0 – 50.8 cm XXL PF010111 PF010211 27.0” – 29.5” 18.5” – 20.0” Page 6 of 7
AccessoriesThe 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 padSize Left RightXS PF040101 PF040201S PF040103 PF040203 The replacement strapM PF040105 PF040205 kit consists of the twoL PF040107 PF040207 regular straps and theXL PF040109 PF040209 two elastic straps. TheXXL PF040111 PF040211 part numbers are:Size LeftXS PF041001S PF041003M PF041005L PF041007XL PF041009XXL PF041011 Page 7 of 7