KNEE STABILIZATION JOINT

(THE SEATBELT KNEE)

Lance Black, Jeremy Theriot, and Mindi Huguet
Louisiana State University

ABSTRACT
Patients with degenerative knee disorders frequently experience knee failure causing them to
fall, facing the risk of injury. Leg braces with a stiff knee joint are one of the few solutions
offered for these patients to support the knee upon failure. These braces, however,
substantially hinder the patient’s gait secondary to the restricted range of motion; cause
additional stress on auxiliary muscles; and provide inadequate shock absorbance (1). The Knee
Stabilization Joint (KSJ) allows for more flexibility and a more natural range of motion thus
eliminating unnecessary hindrance of gait.
Our subject of focus has an illness known as Post Polio Syndrome, a disease affecting more
than 640,000 Americans. This affliction causes our subject to have random instability of his knee
causing unexpected falls unless supported by a brace. His current stiff-legged commercial brace is
overly cumbersome and affects his job performance as a land surveyor.

BACKGROUND
According to the American Academy of Orthopedic Surgeons, 4.1 million individuals seek
professional help for knee problems and injuries each year. The components of knee injury are
numerous and diagnoses range from tendon injuries to neuropathies. In the case pertinent to this
discussion, the patient has a neuromuscular pathology that leads to muscle fatigue thusly causing
knee instability. Common motor neuron disorders affecting the knee include polio, stroke, multiple
sclerosis, cerebral palsy, and cerebral vascular dysfunction (2). Braces can be used in situations of
injury or muscle weakness to provide support, to rehabilitate, or to stabilize. Design of braces,
however, can be difficult due to the complexity of the knee joint’s coordinated movements (3). The
design of an effective knee brace necessitates a thorough understanding of both biomechanics and
kinematics of the knee joint (4,5). Current designs that stabilize the knee incorporate locking
mechanisms that cause awkwardness in gait due to the frequency of locking upon plantar flexion
and resetting during dorsiflexion that is associated with each step. These designs not only hinder
the patient’s gait but also rely on the patient’s ability to undergo both dorsi- and plantar flexion of
the foot. Some of the neurological diseases mentioned above do not allow for these specific
movements in the foot, preventing effective use of current designs.
The ideal design for a leg brace would allow, as close as possible, a normal range of motion
involved in nonpathological gait while supporting the necessary structures. Our design is intended
to resist rotation only at the instance of a fall, allowing the patient to avoid unnecessary locking and
further hindrance of gait (explained in the Design section). A simple analogy would be that of a
seat belt which only truly engages at a dangerous acceleration of the body but at other times allows
for forward motion during routine activities. Imagine a seatbelt that was locked persistently, it
would prevent injury from a motor vehicle accident but it would also severely limit your normal
activities.
The limits of commercial knee braces and orthoses are well known by those who fit and
fabricate them. Our contact, a prosthetist and orthotist, had expressed a similar desire for a
redesigned brace that reflects the concerns of many of his patients who suffer from knee problems
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and who benefit minimally from the current stiff-legged design. Recognition of this problem was
the basis for our group’s decision to evaluate and redesign currently available knee orthoses.
STATEMENT OF THE PROBLEM
Current commercial knee braces do not allow our correspondent, Michael Sliger, appropriate
range of motion found in natural gait causing multiple difficulties at home and at his workplace.
Mr. Sliger’s workplace is dynamic secondary to his demands of surveying multiple locations. On a
typical day, he drives to multiple locations, disembarks from his truck, and walks long distances.
He has discovered with a stiff-legged brace that he has a slowed gait, poor maneuverability, and
difficulty getting in and out of his vehicle. This decrease in function places Mr. Sliger not only in a
position making it difficult to perform his employment duties, but also at a greater risk for further
injuries.
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RATIONALE
The obstacles listed above have resulted in Mr. Sliger having to limit the number of places that
he can manage to survey or visit within a given day. The obvious outcome has been reduction
in wage but more importantly for Mr. Sliger is the auxiliary muscle cramping and aches after a
long day of work.
After speaking with Mr. Sliger it was obvious that this was having an impact not only at work
but his social and home life. The background research for different leg braces that might
benefit Mr. Sliger was disappointing to say the least. There are multiple designs for leg braces
on the current market but most operate very similarly and do not address his entire problem.
Obviously, the ideal leg brace would be one that could provide support and simultaneously
restore the gait back to a
natural state.

DESIGN
Our design evolved
throughout the year with
multiple failures but with
each new design we found a
workable element that could
be incorporated into the
final product. The following
AutoCAD figure (Fig 1) is a
simplified representation of
our final knee design and the
model for our prototype.

The thick
semicircular
line
represents a
spring wire
attached to
the lower member of the knee. The spring has a tab that is pointed
into the page on these figures. The tab is what resists the fall by
pushing against a ledge incorporated in the upper member. Inferior
to the main axis of rotation is a track in which the spring wire tab
rests. This track allows the tab to be pulled out of place to allow
for swing phase; it also provides additional support when the brace
reaches a specific angle. The termination of the track is what will
actually stop knee rotation; the spring is used to slow down the rotational speed, thus preventing a
traumatic stop. Attached to the spring wire is a lifting rod (not included in figure) that will position
the spring in its appropriate place by using the upward force generated by the ground during heel
contact. As seen in Figure 2, a spring-loaded plate will be placed under the heel, triggering the
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spring mechanism in the knee to lock and stabilize for fall prevention. This heel trigger also allows
a patient to fully flex the knee as needed in a seated position by simply taking weight off of the heel.
These mechanisms along with the actual locking device, shown in Figure 1, encompass the
final design that can be incorporated into any leg brace as shown in Figure 3.

DEVELOPMENT
Lambert’s Prosthetics and Orthotics generously donated a knee brace for use in our project.
Based on our subject’s dimensions, we reshaped the brace to comfortably accommodate our model
subject. Once the brace was adjusted, our joint was incorporated and additional modifications were
completed by a professional orthotist. The ability to incorporate our knee into a prefabricated brace
was a priority to our team secondary to the benefits gained by the user. We then incorporated the
trigger mechanism under the sole of the foot. It became necessary to fix the brace to a shoe for two
reasons. The first was to ensure the stability of brace by eliminating any vertical translation of the
brace as the subject walked. Secondly, the heel plate of the trigger mechanism needed to be flush
with the bottom of the shoe’s sole to minimize any imbalances in walking due to height differences.
Lastly, with the cost incurred during development and the analysis of the cost of other orthoses, we
determined the cost of the entire leg orthosis to be approximately $2400.00.
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EVALUATION
As stated, the purpose of our project is to
determine the effect of our knee brace on
the normal motion of Michael Sliger. We
chose to custom fit the brace on one of
our team members instead of our
correspondent in order to be sensitive to
his time restraints and to incorporate
more rigorous testing. Although testing
our design on a subject whose gait is
normal seems unproductive, this testing
will actually closely resemble our
correspondent’s gait. Michael Sliger’s
gait is normal between points of
undesired muscular fatigue; therefore
allowing us to test our brace on its
capability of minimally hindering normal
gait. The muscular fatigue and
subsequent collapse can simply be
replicated by our test subject’s ability to
completely relax the braced leg. We
compared the motions of one subject
under three conditions: uninhibited gait, gait with a commercial leg brace, and gait with KSJ
incorporated leg brace. Motion limitations may include changes in angles at the knee, ankle, or
hip (6); changes in the work requirement of muscles (7); and changes in reaction forces of the
leg (8). This comprehensive analysis required first obtaining anthropometric data and to
comfortably fit the brace to our subject. Next, we used a 2-D tracking system to monitor the
kinematics of the leg in normal gait of the subject in the three phases mentioned above,
uninhibited, with a commercial brace, and with our brace (See Figure 4 for schematic
representation of results). The angle changes we are concerned mostly with are demonstrated
in Figure 4b. Thirdly, we used electromyography (EMG) to study any effects that the use of a
brace may have on the workload of relevant muscles as well as analyzing any additional strain
on auxiliary muscles of the leg and hip (Figure 5 & 6 demonstrate these results). Finally, force
plate analysis allowed us to determine how each brace affects the stability and motion of
individuals (Figure 7). In addition to these, force analysis allows us to determine the ground
reaction forces being applied to the lower limbs of the subject. This is important when
considering pathological and elderly patients and the trauma that can incur throughout the gait
cycle. Using these analyses we compared slow with fast gait as well as falls during these two
speeds.

DISCUSSION
In conclusion, the KSJ resulted in less deviation from normal gait than the commercial brace
while providing adequate support in case of a potential fall. The range of motion of the knee during
swing phase is between 60 and 70° and the range of motion allowed with the KSJ much more
closely resembled this range than did the commercial brace. Though electromyographic results
indicated that there was an increase in muscle activity with the KSJ as compared to normal gait, the
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KSJ results were comparable to the results obtained with the commercial brace. In addition, the
KSJ tested was a prototype, which weighed approximately four times that of the commercial brace.
The actual knee will weigh significantly less and it is expected that, as a result, the amplitudes of
the EMG signals would then more closely resemble that of the normal gait.
Therefore, based on our preliminary testing, we have successfully met all of the objectives
of our project and proven the effectiveness of our design. Research needs to be expanded to include
testing on a larger subject population including those with actual disease. In addition, there are
several recommendations we would suggest in the further pursuit of this project. First, the
AutoCAD drawings represent a finalized design, which has not yet been fabricated. As a result of
our new design, the weight of the joint would be reduced and this may have a positive impact on the
analysis of both the effects on the muscles (EMG) and the ground reaction forces (force plate
analysis).
Unfortunately, time and resources were limiting factors in implementing our final design to
our subject. He has graciously donated his time in multiple interviews and is excited about our
project.
REFERENCES
1. Paul, J. M. (1999). Strength Requirements for Internal and External Prostheses. Journal of
Biomechanics, 32(4):381-393.
2. Dingwell, J.B. et al. (2000). Slower Speeds in Patients with Diabetic Neuropathy Lead to
Improved Local Dynamic Stability of Continuous Overground Walking. Journal of
Biomechanics. 33(10):1269-1277.
3. Collins, J.J. and O’Conner, J.J. (1991). Muscle-Ligament Interactions at the Knee During
Walking. Proceedings of the Institution of Mechanical Engineers, Part H, 205, 11-18.
4. Hurmuzlu, Y. and Basdogan, C. (1994). On the Measurement of Stability in Human
Locomotion. Journal of Biomechanics, 116:30.
5. Winter, David A. (1991). The Biomechanics and Motor Control of Human Gait. University
of Waterloo Press.
6. Chan, S.C.N. and Seedhom, B.B. (1999). Equivalent Geometry of the Knee and the
Prediction of Tensions Along the Cruciates: an Experimental Study. Journal of
Biomechanics, 32:35-43.
7. De Luca, C. and Basmajian, J. (1979). Muscles Alive. Williams & Wilkins Baltimore, Md.
8. Morrison, J.B. (1968). Bio-engineering Analysis of Force Actions Transmitted by the Knee
Joint. Bio-medical Engineering, 3:164-170.
9. Anderson, F. C. and Pandy, M. G. (2001). Static and Dynamic Optimization Solutions For
Gait are Practically Equivalent. Journal of Biomechanics, 34(2):153-161.

ACKNOWLEDGEMENTS
We would like to thank Dr. Randy Price, our advisor, for supporting our design and keeping
us focused and on a timely track; Jack Spring and coworkers, for their time, resources, expertise,
and overall support; lastly, Michael Sliger, our correspondent, for presenting to our group a problem
that has been overlooked.

FIGURE DESCRIPTIONS
Figure 1. Knee Stabilization Joint – Illustration of the knee joint at rest, standing and swing phase.
Figure 2. Heel Trigger – An AutoCad representation of the spring-loaded heel plate
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Figure 3. KSJ Incorporated – Our completed prototype incorporated into a leg orthosis
accompanied by our final AutoCad rendition.
Figure 4. Gait Comparison of Fast Trials – Stick figure representation of the leg without a brace,
with commercial brace, and with KSJ-incorporated brace.
Figure 4B. Angle Definitions – Illustrations of angles of the lower extremity used to study gait
Figure 5. Knee Angle Comparisons – Graph showing the different knee angles throughout swing
and standing phase under three previously defined modes (unrestricted, commercial brace, & KSJ).
Figure 6. EMG of Gluteus Medius Comparison – Graph showing the work of the gluteus medius of
test subject under three modes.
Figure 7. Weight Transference of Acceptance – Graph showing pressure at foot of braced leg under
three modes. * All figures use data obtained from test subject – Mindi Huguet

INITIAL AUTHOR
Lance M. Black
997 John Wayne Circle
Fort Walton Beach, FL 32547
ADDITIONAL FIGURES

B
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