Jack PCL. Posterior Cruciate Ligament Brace brace ORTHOPAEDIC
Jack PCL Brace The Jack PCL brace neutralises the effect of gravity on the calf, supporting and protecting the PCL. As a result, posterior sagging of the knee is avoided. The anterior directed translation force comes from the spring tension in the joint. This force is individually adjustable to the size and weight of the patient s leg. Indications: Post-operative and conservative treatment of PCL tears. Wearing time of the brace Experience has shown that if the brace is only utilised for two months there is a risk of instability re-occurring, since the collagen is still under re-vascularisation. We therefore recommend that the Jack PCL brace is worn for 3 to 4 months. Before surgery it is therefore important to explain to the patient the principles behind the product so that he/she is convinced of the necessity to wear the brace 24 hours a day for the full rehabilitation period. If the patient removes the brace at night, or loosens the straps, the effect will immediately be gone and the graft is exposed to gravity and most likely to stretching. For a conservative treatment the Jack PCL brace should be applied within the first two weeks post trauma. Quadriceps & Hamstrings Training Active muscle exercises are done right from the start, using quadriceps training to avoid too much muscular atrophy. This is combined with electrodes that are glued underneath the anterior half shell for muscle stimulation and can be used from 3 to 5 hours a day. For hamstring training the patient is put in a prone position and then the brace can be removed. We recommend the ischiocrurals to be trained from the hip area with the knee in 20 of flexion and the hip in hyperextension to avoid an unfavourable force vector. Partial weight bearing of 15kg to 20kg is used for the first 8 weeks.
Principles of the Jack PCL Brace 1 The Problem: Rehabilitation of the knee joint after reconstruction of the posterior cruciate ligament heavily loads the reconstructed ligament, especially when the foot is resting on the floor and the leg is hanging through, as in sitting position diagram A, or if the ischiocrural muscles are contracted during active flexion of the knee as in diagram B. The consequence is elongation of the transplant and recurrence of posterior instability. A B 2 The Goal: In order to prevent the graft from elongating, posterior sag of the knee must be avoided during the rehabilitation phase until the transplant is revascularised and matured using a counter force of corresponding size during this 3 to 4 month period, as in diagram C. C During conservative treatment, the constant support and protection of the ruptured ligament is essential to avoid the ligament healing in an elongated condition. 3 The Solution: Using the Jack PCL brace, the posterior draw position is avoided independent of the degree of flexion of the knee joint. D The principle of the brace is based on a separation between motion of rotation and translation of the tibia against the femur during flexion-extension as in diagram D.
Application Instructions 1 Preparation 1 2 3 4 5 6 7 Adjust the length of all brace straps to maximum length. The straps do not have to be pulled out of their lugs. Release the anterior straps by opening the buckles and take out the additional thigh shell. Deactivate spring tension - (see text and diagrams in the next column). When attaching the brace for the first time, a second person should support the calf in order to relieve the posterior cruciate ligament. 2 Application of the brace Attach the brace from behind to your leg 1 and put the additional thigh shell from above between the thigh shells 2. Make sure to align the pivotal points of the orthosis joints with the pivotal point of the knee. Then put the distal anterior thigh strap over the additional thigh shell 3 and close it using the strap fastener. Adjust the length of the strap so that the thigh shells adjust themselves parallel to the thigh. Then adjust the length of the posterior proximal thigh strap 4 and make sure, that the shells are still aligned parallel to the thigh. Fasten the anterior upper thigh strap above the hook and loop point of the additional thigh shell 5. Then adjust the length of the posterior thigh strap near the hinge 6. Now attach the calf shell to your leg and close the calf strap together with the additional calf shell 7. After fastening the single straps, check the position of the brace and if necessary, readjust it. Please take care, that the straps are not fastened too tightly, so that blood circulation is not affected. After attaching the brace activate spring tension as described in the text and diagrams in the next column. When removing the brace, ensure spring tension is deactivated. Only release the anterior straps. The adjusted length of the straps remains unchanged. The spring tension causes an anterior directed translation force to protect the PCL from elongation. To maintain the effectiveness of this force it is imperative that the following straps marked! are fastened firmly 8. Calf strap Anterior distal thigh strap Posterior proximal thigh strap The function of the brace will be lost if one of the straps loosens or is not fastened firmly enough.!! 8! 1 Tension lever 2 Spring tension control 3 Turning Knob 4 Spring tension adjustment arrows 5 Spring load indicator 6 Pivotal point 7 Heading rod Spring tension The spring can be activated / deactivated at the joint, see above picture. The adjusted tension remains unchanged. To deactivate the spring set the tension lever 1 to -. Push the heading rod 7 towards the lower leg rod to its limit - red arrow. To activate the spring set the tension lever 1 to +. Push the heading rod 7 again towards the lower leg rod to its limit - red arrow. Adjustment of spring tension When adjusting the tension load, make sure that the spring is activated - see above. Increasing tension load Set turning knob 3 to +. Load spring to desired tension (max. load is 15) by turning the spring tension adjustment 2 in direction indicated by arrows 4 using the supplied tool. Level of load is indicated in window 5. Decreasing tension load Set turning knob 3 to -. Load spring slightly by turning the spring tension adjustment 2 in direction indicated by arrows 4 using supplied tool. The mechanism will be unlocked and the spring can be unloaded back to 0. Adjustment of limit stops for extension and flexion Remove the condyle pads from the inside of the hinges. Remove both hinge covers by loosening the screw 8 of each cover. Under one cover the reserve stops for limitation are stored. Under the other cover there are drill-holes marked with degrees, in which the stops can be positioned according to the requested degrees. 8 9 Covers must be reinstalled after adjustment. Removal of limitation stop In case there are no limitation stops installed, the maximum range of motion of the brace is 0 in extension and 90 in flexion. If the range of motion needs to exceed 90 during the course of treatment, the limitation pin can be unscrewed using a hexagon spanner size 2.5 or a Torx size TX-10 9.
Ordering of Products ROM - Feature The Jack PCL brace is available excluding or including limitation. By selecting the brace with limitation you will have the following choice of settings: FLEXION: 15 / 25 / 35 / 45 / 55 / 65 / 75 / 90 EXTENSION: 0 / 15 / 25 / 35 / 45 Measurement: To enable you to select the most appropriate option we simply need one measurement, which is the maximal circumference of the calf. Small: up to 33 cm Medium: up to 40 cm Large: more than 40 cm maximal circumference of the calf WITH LIMIT WITHOUT LIMIT CODE CODE 885 c - L Small Left 880 c - L Small Left 885 a - L Medium Left 880 a - L Medium Left 885 b - L Large Left 880 b - L Large Left 885 c - R Small Right 880 c - R Small Right 885 a - R Medium Right 880 a - R Medium Right 885 b - R Large Right 880 b - R Large Right Order Details: Please ensure the correct code is on your order. Products can be ordered by email, fax, post, or telephone if supported by an official Purchase Order Number. Prices are exclusive of VAT. Service: All in stock goods will be dispatched same day providing the order is received by 3.00pm. Replacement liners and straps can also be purchased. Carriage is 10 + VAT. Special delivery is available on request and will be quoted for accordingly. Returns do not incur a further charge if they are unused and returned promptly with all the original packaging and instructions. Confirmation Orders: To avoid the duplication of a verbal order it is essential that any written confirmation is clearly marked confirmation order. Terms of Business: Our standard terms of payment are strictly net 30 days from date of invoice. Prices given do not include VAT. Non-receipt of goods must be notified in writing to the company within 10 days of the date of advice of dispatch or invoice. Our full terms and conditions of business are available on request.
Jack PCL Posterior Cruciate Ligament Brace brace ORTHOPAEDIC Unit 8, Evans Business Centre, Orion Way North Shields, Tyne & Wear NE29 7SN TELEPHONE: 0191 258 8944 FACSIMILE: 0191 258 8946 EMAIL: sales@braceorthopaedic.co.uk WEBSITE: www.braceorthopaedic.co.uk