AL Rehab

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 4-points-of-leverage.

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 knee extension.

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

Also available: Adjustable OA Defiance®

  • Designed for the active OA patient, custom made Adjustable OA Defiance provides durable support for moderate to severe levels of osteoarthritis.
  • 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.

Contact us

Please feel free to contact us for more information on our products and our services or for any other questions or comments.



Address: New Nabooda building, Oud Metha, Dubai-UAE.
Tel: +971 4 2250 323


Address: G2-Saleh Bin lahej, Buhaira Corniche, Sharjah-UAE.
Tel: +971 6 550 7507