Customized Dynamic Bracing

CKD on leg CKD on patient leg

The Advanced Orthopedic Therapy at Sinai Rehab Center team develops innovative devices to stretch your stiff knee, ankle, or elbow, such as a custom knee device (CKD). These devices have been successfully applied to more than 2,500 patients. These unique solutions are available only through our therapy program. To schedule an appointment with Advanced Orthopedic Therapy at Sinai Rehab Center, call 410-601-5945.

What is a CKD?

A Custom Knee Device (CKD) is a removable brace that is custom-made for your leg to increase the bending and/or straightening of your knee. CKD bracing was developed in 2001 by Anil Bhave, PT, Clinical Director of Rehabilitation at Advanced Orthopedic Therapy at Sinai Rehab Center. It is made with a special type of casting material which allows it to be removable. It consists of two cast portions, hinges, and an elastic band or crank. The brace is made at Advanced Orthopedic Therapy at Sinai Rehab Center. It takes about one hour for your cast to be made and then you will be taught how to use it and take it with you the same day.

What does a CKD do?

A CKD provides a variable-load, long-duration stretch to your knee to gradually increase your range of motion. It should gradually become mildly uncomfortable while you are wearing it due to the stretch. It is flexible and dynamic so you can have a break while stretching.

Why do I need a CKD?

Patients are recommended for a CKD if your knee is not moving as much as your doctor or physical therapist would like. This could be due to a lack of bending or straightening. The inability to fully bend or straighten your knee will increase your pain and decrease your knee function, such as walking and climbing stairs. We will need to get a prescription from your doctor before a CKD appointment is made.

What do I do with my CKD?

The removable CKD is worn for certain prescribed periods during the day or night while resting, but not while walking. It is tightened either by wrapping it with TheraBand™ or turning a hinge with a provided lever.

Why do CKDs work?

CKDs provide a long-duration stretch to the stiff joint to increase the range of motion. The amount of pressure can be adjusted based on the color and amount of pull on the TheraBand™. This allows for tissue "creep" to increase the motion at the joint permanently. Long-duration stretch at lower loads allows for increased total compound stretch (Force*Time). For example, if a CKD is worn for 1 hour per day and it applies a torque of 15 ft/lbs, the total compound effect is 900 lbs/min per day. For comparison, even if you get 50 ft/lbs of stretch in a typical therapy session and if you perform 15 stretches for 20 seconds duration, the total force per day is 250 lbs/min. This physiologic property of optimal stretch over longer duration allows for plastic remodeling of the soft tissue around your joint, which leads to improved range in your knee joint.

How well do CKDs work?

In a published study, 27 of 29 patients with a primary total knee replacement and 13 of 18 patients with a revision total knee replacement achieved full knee extension with a CKD after a mean time of 9 weeks, after failing standardized conventional therapy. The patients in this study also had a significant increase in knee functional scales after CKD use.

In another published study of 27 legs after an average of over 5 cm of internal femoral lengthening, only 2 legs did not get fully straight after an average of 3.8 weeks of treatment with a CKD and specialized physical therapy.