As we previously discussed in our introduction to knee bracing for low to moderate grades of injury - knee bracing has advanced over the years. This, as well as changes in practice and prescription have made higher grade bracing more difficult.
Moderate to severe injuries require further support including additional strapping, further mediolateral support from a hinge or joint and longer lever arms. These braces reduce force and torsion in the leg and aid healing for injuries such as moderate to severe MSK injuries (eg. grade 2 Medial collateral ligament injury) severe patella tendinitis, severe meniscus damage, severe arthritis or arthrosis with instability and pre or post surgical intervention.
Most clinicians will be familiar with longer, larger style stabilizing knee braces for higher grade injuries or for pre and post operative care. These are usually referred to as ROM braces (Range Of Motion braces). They offer the most support as they have firm side steels, long lever arms and range of motion restriction joints which can specifically restrict how much flexion and extension the patient has in their knee.
The down side of some of these braces is that even with a good fitting, which is contoured well to the patient's leg, they can migrate distally. They also tend to be quite obtrusive and warm.
There are now other options for these higher grade injuries, especially if they are able to weight bear relatively well, don't have wounds or sutures and don't have excessive swelling.
This knee brace has a shorter lever arm than most range of motion braces making it easier to use. It also holds firmly in place due to the graded compressive CRX material. This results in the knee brace not migrating down the leg and allows the side steels and knee joint to be in the correct position offering optimal support and comfort. It also has an integrated silicone pad for specific patella support.
Additionally, it includes strong aluminium side steels and the hinge joint has easy to use flexion and extension stops. These just click in and out of the joint and restrict the range for the patient to rehabilitate safely. The stops are made from injection molded nylon and can stop extension in 0°, 10°, 20°, 30° and 40° as well as flexion 45°, 60°, 75° and 90°.
The hinge covers have a special design which makes it possible to adjust the range of motion when the hinge is fitted in the brace. The covers are open on the back side and can slide forward or backward to access the opening in the hinge. The covers are made from a robust kevlar which stops them wearing with the force from the hinge.
The straps on the CRX Liga X also give more support. They are easy to use D-loop velcro strap with low profile hook. They can be adjusted for shape changes due to swelling and also reduce the risk of this moving out of position.
Furthermore it includes a very effective cross system strap at the popliteal area. This again stabilizes other forces in the knee brace and if the patient is hyperextension it offers an anterior force through the popliteal region to reduce this. If the knee hyperextension is excessive, you can also use the flex/ext stops to hold the patient in a flexed position until you have time to get them the additional orthoses they may need.
For large or conical shaped thighs there is a new option called PLUS. These sizes are available from M-XXXL and have 3 cm wider circumference over the thigh but the same circumference around the knee and calf as the standard sizes.