Knee Ligament Bracing™
Through the 4-Points-of-Leverage rigid cuff and strap configuration, a posterior force is applied to the tibia preventing anterior movement.
The 4-Points-of-Leverage brace design:
- Significantly reduces ACL strain*
- Provides a constant dynamic load
Point of Leverage #1
The tibia is anchored by a cuff placed at the bottom of the posterior calf.
Point of Leverage #2
The femur is anchored by a cuff placed at the top of the anterior thigh.
Point of Leverage #3
A strap across the back of the lower thigh pushes the femur anteriorly.
Point of Leverage #4
A strap placed on the anterior tibia applies an active constant load to prevent anterior tibia translation.
*Fleming et al. (2000), The influence of functional Knee Bracing on the ACL Strain Biomechanics in Weightbearing and Nonweightbearing Knees, The American Journal of Sports Medicine,Vol., Nr. 6, p. 815-824
Fitting Instructions for an ACL 4-Point Brace
How the DonJoy 4-Point Brace Protects the ACL Deficient Knee
Patients with an ACL deficient knee have an anterolateral
instability that causes the knee to give way.
It is very difficult to control instability in an ACL deficient
knee in a direct way using a knee brace.
Indirect stabilisation of the knee is achieved with the
biomechanical 4 point design of the DonJoy brace.
The 4-point system is clinically proven to be the most
effective way to prevent anterior translation of the tibia.
A DonJoy brace will provide a high level of stability for the
ACL deficient knee by effectively reducing or preventing
the anterior tibial translation through the use of the
FourcePoint™ Hinge Technology
Aggressive eccentric contractions of the quadriceps produce significant anterior tibial translation and can injure the ACL or permanently stretch out an ACL
graft (DeMorat et al., AJSM, 2004). Additional studies show quadricep-intensive activities should be avoided at joint angles, particularly the last 30 degrees of
extension, when strains are at a maximum. DJO has developed a hinge to address maximising ACL and ACL graft protection in these “at risk” positions.
Small knee flexion angles at initial contact during landing tasks may contribute to ACL injuries. The FourcePoint Hinge can be used to control joint range-ofmotion
by increasing the knee flexion angle during landing, resulting in a decrease of anterior shear force on the ACL by 9-13% (Garret and Yu, AJSM, 2004).
The DonJoy FourcePoint utilises a spring mechanism in the hinge to apply gradually increasing resistance during knee extension. The resistance engages in
the last 25 degrees of extension (relative to the extension stop).
The hinge has three levels of resistance with the option to turn off resistance if appropriate.
The resistance serves three critical roles:
- First, it reduces the time spent near full extension or in the “at risk” position.
- Second, it increases the posterior load applied by the brace on the tibia to prevent anterior tibial translation.
- Third, it eliminates the extension shock felt when a patient extends into a 10 degree standard rigid stop.
FourcePoint Hinge Technology works to enhance DonJoy’s 4-Points-of-Leverage design by damping knee joint extension, which improves the mechanical
performance of the brace and reduces shear forces at the knee. Addressing the “at-risk” position, the hinge resistance engages in the last 25 degrees of
The FourcePoint hinge combined with the 4-Points-of-Leverage cuff and strapping design provides a more comfortable brace that reduces anterior shear
forces at the knee. Decreasing anterior shear forces at the knee is beneficial for patients by reducing strain on the healing ACL graft, providing stability to
an unstable, ACL deficient knee or for prophylactic use.
Defiance® III / Defiance® Color Options
CCMI Mark III - Measuring Device
The Custom Contour Measuring Instrument (CCMI) is
used to measure custom DonJoy Defiance and Defiance III
braces. The device takes into account fourteen separate
anatomical reference points from the patient’s leg
indicating thigh and calf circumference, thigh and calf
contours, as well as knee width and varus/valgus.
- Sleek design to determine leg contour measurements for the construction of a DonJoy custom brace
- Retractable tape measures for quick and accurate measurements
- Standard and Short brace measuring options
- Easy to use and collapsible
- Thigh and calf contour gauges
Defiance® III / Defiance®
DonJoy Defiance sets the industry standard for Custom Made Knee Braces. A host of options allows customisation of the fit and functions, to ensure
maximum protection and confidence. The ultimate in technology, materials and design. Defiance incorporates DonJoy's patented 4-Points-of-Leverage for
effective support, and offers a choice of patented hinge designs.
Moderate to severe ACL, PCL, CI, MCL and LCL instabilities.
Features and Benefits
- Clinically-proven 4-Points-of-Leverage System
- Custom fabricated
- Strong, lightweight carbon composite frame
- Swooping thigh cuff for inner thigh clearance (Defiance III)
- Swiveling strap tabs to accommodate leg movement
- Anti-migration band for enhanced brace suspension
- Supra-Condyle pad promotes brace suspension
- Flexion and Extension control
- Lightweight, low profile design
- Lifetime warranty on frame and hinges
- Patented clinically-proven FourcePoint hinge technology
- Over 40 custom frame colors and graphics
- Defiance III Extra includes reinforced carbon composite frame
- PowerCaps—metal strap tab caps (recommended for contact sports)
- High strength stainless steel gears (recommended for contact sports)
- ACL, PCL, or Combined Instability (CI) strap configurations
- Standard or short frames available
Adjustable OA Defiance®
- Designed for the active OA patient, custom made Adjustable OA
Defiance provides durable support for moderate to severe levels
- The bilateral hinge bars offer support for ligament instabilities and
work in conjunction with a patented telescoping condyle pad which
puts the load control in the hands of the patient.
- The 3-Point Off-loading mechanism shifts load away from the
damaged part of the knee.