Abstract:
An orthopedic apparatus includes an orthopedic knee brace including at least one hinge, an adjustable pad removably attachable to the hinge, the adjustable pad including a top plate, a base plate, an adjuster located between the top plate and the base plate, at least one ramp including a plurality of ramp angles, the ramp inclined so that at least two of the ramp angles are spaced differently from a foot of the ramp, and at least one spoke positioned and arranged to selectively engage one of the ramp angles of the at least one ramp to set an overall height of the pad, and wherein the adjustable pad is installable on the brace hinge for adjusting the side force applied to the user&#39;s knee to help relieve the pain of medial or lateral unicompartmental osteoarthritis while providing additional stability for ligament or cartilage insufficiencies.

Description:
PRIORITY CLAIM 
     This application claims priority to and the benefit of U.S. Provisional Patent Application No. 61/418,711, entitled, “ADJUSTABLE PAD FOR AN ORTHOPEDIC KNEE BRACE”, filed Dec. 1, 2010, the entire contents of which are incorporated herein by reference and relied upon. 
    
    
     BACKGROUND 
     The present disclosure relates generally to orthopedics and more particularly to dynamic knee bracing. 
     Unicompartmental osteoarthritis of the knee affects millions of individuals. Most nonsurgical management of this progressive disease is primarily directed at reducing inflammation and pain with medication. Evidence supports the clinical efficacy of bracing for managing osteoarthritis of the knee. In some patients, bracing significantly reduces pain, increases function, and reduces excessive loading to the damaged compartment. A variety of health and functional status instruments, techniques and investigations, have been used to evaluate the unloading capabilities of such braces. The braces have been shown to load share and thus reduce the stresses in the degenerated medial compartment of the knee. 
     A need exists for an improved device for treating and/or aiding unicompartmental osteoarthritis. 
     SUMMARY 
     The adjustable pad in general is a pad that is placed between the inside or outside of the user&#39;s knee and the brace, and which is turned to produce a corresponding translational expansion or contraction of the pad to respectively increase or decrease pressure applied to the user&#39;s knee. The adjustable pad can be installed on a double upright hinged functional knee brace forming an overall orthopedic apparatus. The adjustable pad and knee brace provide an apparatus and method of adjusting the side force applied to the user&#39;s knee to help relieve the pain of medial or lateral unicompartmental osteoarthritis while providing additional stability for ligament or cartilage insufficiencies. 
     To the above ends, and without limiting the following description, in a first aspect of the present disclosure, an orthopedic apparatus includes: an orthopedic knee brace including at least one hinge; and an adjustable pad removably attachable to the orthopedic knee brace, the adjustable pad including a top plate, a base plate, an adjuster located between the top plate and the base plate, at least one ramp including a plurality of ramp angles, the ramp inclined so that at least two of the ramp angles are spaced differently from a foot of the ramp, at least one spoke positioned and arranged to selectively engage one of the ramp angles of the at least one ramp, and wherein (i) the at least one ramp is provided on one side of the adjuster and the at least one spoke is provided on one of the top plate or the base plate, (ii) at least one ramp is provided on each of two sides of the adjuster and at least one spoke is provided on both the top and base plates, (iii) the at least one ramp is provided on one of the top or the base plate and the at least one spoke is provided on a mating side of the adjuster, or (iv) at least one ramp is provided on both the top and the base plate and at least one spoke is provided on each of two sides of the adjuster. 
     In accordance with a second aspect of the present disclosure, which may be used in combination with the first aspect, the adjustable pad is removably attachable to the orthopedic knee brace via a hook and loop attachment. 
     In accordance with a third aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, the knee brace includes medial and lateral hinges, and wherein the adjustable pad can be selectively attached to either of the hinges. 
     In accordance with a fourth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, for at least (iv) the top plate and the base plate are positioned relative to each other such that the circular ramp of the top plate is concentric with and adjacent to the circular ramp of the base plate. 
     In accordance with a fifth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, for at least (iii) or (iv) the spoke includes at least one of an upper ramp angle that is shaped to mate with the ramp angles of the top plate and a lower ramp angle that is shaped to mate with the ramp angles of the base plate. 
     In accordance with a sixth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, for at least (iii) or (iv) at least one of the top plate and the base plate includes N number of ramps, and the adjuster ring includes N number of spokes for operation with the N number of top and/or base plate ramps. 
     In accordance with a seventh aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, the adjuster rotates relative to the top and base plates. 
     In accordance with an eighth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, one of the top or the base plates includes at least one tab that extends in a cantilevered manner from a wall of the plate, the adjuster including at least one feature for receiving a mating feature of the at least one tab, the receiving of the feature and the mating feature coinciding with an adjustment setting of the adjustable pad. 
     In accordance with a ninth aspect of the present disclosure, which may be used in combination with the eighth aspect, the adjuster includes an interior ring forming the at least one feature, and wherein the at least one spoke can be secured between the inner ring and an outer ring of the adjuster. 
     In accordance with a tenth aspect of the present disclosure, which may be used in combination with the eighth aspect, the other of the top or base plate defines at least one aperture for receiving the at least one tab to allow the adjustable pad to be compressed without the at least one tab abutting the other of the top or base plate. 
     In accordance with an eleventh aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, the adjuster includes a handle for a user to rotate the adjuster for setting adjustment, the handle extending from the adjuster an as to reside outside of the top plate and base plate when the plates are mated. 
     In accordance with a twelfth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, one of the base plate or top plate includes at least one (e.g., spring-like) finger extending from a wall of the plate, and the other of the base plate or the top plate includes at least one receiver post or aperture for capturing the at least one finger for stabilizing the base and top plates when the plates are moved towards or away from each other. 
     In accordance with a thirteenth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, the at least one ramp is compressed against the at least one spoke by at least one spring. 
     In accordance with a fourteenth aspect of the present disclosure, which may be used in combination with the thirteenth aspect, the at least one spring is (i) an extension spring in mechanical communication with the top and base plates or (ii) a compression spring applying a compression force to the top plate or the base plate. 
     In accordance with a fifteenth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, one of the top or the base plate is configured to be removably attached to the knee brace, while the other of the top or the base plate includes or is attached to padding for comfortable engagement with a user of the orthopedic apparatus. 
     In accordance with a sixteenth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, one of the top plate or the base plate includes a lip that extends past the other of the top or base plate, the lip sized and arranged to fit around the periphery of the at least one hinge to provide mounting stability. 
     In accordance with a seventeenth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, for at least (i) or (ii), at least one ramp on the adjuster engages at least one spoke provided on the base plate, and wherein a fastener extends through the base plate and is attached to the top plate. 
     In accordance with an eighteenth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, an orthopedic apparatus includes: an orthopedic knee brace including at least one hinge; and an adjustable pad removably attachable to the orthopedic knee brace, the adjustable pad including a plate including at least one semi-cylindrical ramp having a plurality of ramp angles, at least two of the ramp angles spaced differently from a primary wall of the plate, an adjuster located adjacent to the plate and including at least one spoke shaped and positioned to selectively engage the ramp angles of the at least one ramp to set a desired overall height of the adjustable pad, and at least one spring is positioned and arranged to compress the plate to the adjuster regardless of which ramp angle that the at least one spoke is engaged. 
     In accordance with a nineteenth aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the eighteenth aspect, the plate is a first plate and the at least one semi-cylindrical ramp is a first semi-cylindrical ramp, and which includes a second plate including at least one second semi-cylindrical ramp having a plurality of ramp angles at least two of which are spaced differently from a primary wall of the second plate, the at least one spoke selectively engaging one of the ramp angles of the at least one second semi-cylindrical ramp of the second plate, the at least one spring positioned and arranged to compress the first and second plates and the adjuster regardless of the position of the at least one spoke. 
     In accordance with a twentieth aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the eighteenth aspect, the ramp angles of the at least one semi-cylindrical ramp increase sequentially in distance from the primary wall from a most-compressed adjuster pad ramp angle to a most-expanded adjuster pad ramp angle. 
     In accordance with a twenty-first aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, an orthopedic apparatus includes: an orthopedic knee brace including at least one hinge; and an adjustable pad removably attachable to the orthopedic knee brace, the adjustable pad including an adjuster including at least one semi-cylindrical ramp having a plurality of ramp angles, at least two of the ramp angles spaced differently from a foot of the ramp, a plate located adjacent to the adjuster and including at least one spoke positioned to be selectively engaged by the ramp angles of the at least one ramp to set a desired overall height of the adjustable pad, and at least one spring positioned and arranged to compress the adjuster to the plate regardless of which ramp angle has been engaged to the at least one spoke. 
     In accordance with a twenty-second aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-first aspect, the plate is a first plate and the at least one spoke is a first spoke, and which includes a second plate including at least one second spoke, and wherein the at least one semi-cylindrical ramp is a first at least one semi-cylindrical ramp and the adjuster includes a second at least one semi-cylindrical ramp engaging the second spoke, the at least one spring positioned and arranged to compress the first and second plates and the adjuster together regardless of the position of the adjuster. 
     In accordance with a twenty-third aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-first aspect, the ramp angles of the at least one semi-cylindrical ramp increase sequentially in distance from the foot of the ramp from a most-compressed adjuster pad ramp angle to a most-expanded adjuster pad ramp angle. 
     In accordance with a twenty-fourth aspect of the present disclosure, which may be used in combination with any one or more of the preceding aspects, an orthopedic bracing method includes: enabling an orthopedic knee brace to place a user-selectable side load on a user&#39;s knee by allowing the user to manipulate an adjuster, wedging the adjuster at different locations within first and second plates located on either side of the adjuster, thereby sequentially increasing a distance between the adjuster and at least one opposing wall of the respective first and second plates to sequentially increase the side load; and compressing the first and second plates to the adjuster throughout the sequential increasing. 
     In accordance with a twenty-fifth aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-fourth aspect, wedging the adjuster includes moving an inclined ramp against a fixed spoke. 
     In accordance with a twenty-sixth aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-fourth aspect, wedging the adjuster includes moving a spoke against a fixed inclined ramp. 
     In accordance with a twenty-seventh aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-fourth aspect, the method includes enabling manipulation of the adjuster (i) in a first direction to sequentially increase the distance and the side load and (ii) in a second direction to sequentially decrease the distance and the side load. 
     In accordance with a twenty-eighth aspect of the present disclosure, which may be used with any one or more of the preceding aspects in combination with the twenty-seventh aspect, the method includes compressing the first and second plates throughout the sequential decreasing. 
     In accordance with a twenty-ninth aspect of the present disclosure, any of the structure and functionality illustrated and described in connection with  FIGS. 1 to 11  may be used in combination with any of the structure and functionality illustrated and described in connection with any of the other of  FIGS. 1 to 11  and with any one or more of the preceding aspects. 
     In light of the above aspects, it should be appreciated that it is an advantage of the present invention to provide an improved orthopedic knee brace. 
     It is another advantage of the present invention to provide an improved telescoping compressible and expandable pad for an orthopedic knee brace. 
     It is a further advantage of the present disclosure to provide an adjustable orthopedic knee brace pad that is lightweight but sturdy. 
     It is yet another advantage of the present disclosure to provide an adjustable orthopedic knee brace pad that can be placed on either side of the user&#39;s knee. 
     It is yet a further advantage of the present disclosure to provide an adjustable orthopedic knee brace pad that provides an even load around a periphery of the pad. 
     It is still another advantage of the present disclosure to provide an adjustable orthopedic knee brace pad that is stable when placed on the knee brace but is readily removeable from the knee brace. 
     Additional features and advantages are described herein, and will be apparent from the following Detailed Description and the figures. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1  is an exploded perspective view of one primary embodiment of an adjustable pad of the present disclosure including, from left to right, a hook or pile sheet, springs, a top plate, an adjuster ring, a base plate, a rod and a base pile or hook layer. 
         FIG. 2  is a perspective view of one embodiment of a base plate of the adjustable pad of the present disclosure. 
         FIG. 3  is a perspective view of one embodiment an adjuster ring of the adjustable pad of the present disclosure. 
         FIG. 4  is a perspective view of one embodiment a top plate of the adjustable pad of the present disclosure. 
         FIG. 5A  is a perspective view of one embodiment of an assembled and fully compressed adjustable pad of the present disclosure shown from the base plate side of the pad. 
         FIG. 5B  is a perspective view of one embodiment of an assembled adjustable pad of the present disclosure shown from the top plate side of the pad. 
         FIG. 6  is a simplified sectioned, schematic view of the one embodiment of an assembled adjustable pad of the present disclosure. (note: the twp ramps actually scissor past one another when the base plate and top plate are fully collapsed—that is why they are adjacent and concentric curved ramps) 
         FIG. 7  is a perspective view of one embodiment the adjustable pad of the present disclosure positioned in mounting relationship with an orthopedic knee brace. 
         FIG. 8  is an exploded perspective view of an alternative primary embodiment of an adjustable pad of the present disclosure including, from left to right, a mounting screw, a pressure washer, a compression spring, a base hook or pile layer, a base plate, an adjuster, a threaded mounting insert, a top plate, a top plate pile or hook layer, a pad hook or pile layer, and a cushioned pad. 
         FIG. 9  is a perspective view of one embodiment of the adjuster of the primary embodiment of  FIG. 8 . 
         FIG. 10  is a perspective view of one embodiment of the base plate of the primary embodiment of  FIG. 8 . 
         FIG. 11  is a perspective view of one embodiment of an assembled adjustable pad of the primary embodiment of  FIG. 8 . 
     
    
    
     DETAILED DESCRIPTION 
     First Primary Embodiment 
     One primary embodiment for an adjustable pad is shown and described in connection with adjustable pad  10  and  FIGS. 1 to 7  as follows.  FIG. 1  is an exploded view showing the different pieces of adjustable pad  10 . From left to right, hook sheet  18  is adhered to the top wall  16   a  of top plate  16 . The hook sheet  18  indexes a hook surface that removably attaches to a pile surface of a cushioned or gel encapsulating pad  19  illustrated below that has inner cushioning foam or gel. The outer surface of the cushion is soft, e.g., felt, and abuts the user&#39;s knee. The inner surface of the cushion includes pile material that attaches to hook material provided on the outer surface of sheet  18 . Hook sheet  18  is adhered to an assembly that includes top plate  16 , an adjuster ring  14  and a base plate  12 , discussed in detail below. Top plate  16 , adjuster ring  14  and base plate  12  can each be made of plastic, metal or some combination thereof. A base pile layer  20  is adhered to the inside surface of base plate  12 . Base pile layer  20  enables the assembled adjustable pad  10  to be removably connected to hook material provided on either hinge of a knee brace ( FIG. 7 ). A label  15  is provided on, e.g., adhered to, base plate  12  to provide an indication of the current state of expansion for adjustable pad  10 . 
     For purposes of disclosure, sheet  18  has been described as having hook material, while layer  20  has been described as having pile material. It should be appreciated that for any embodiment of the adjustable pads of the present disclosure, a surface can have hook or pile material interchangeably. 
       FIG. 2 . illustrates base plate  12  in more detail, while  FIG. 3  illustrates adjuster ring  14  in more detail. In  FIG. 2 , a second ring  12   b  residing outwardly from a center ring  12   a  of base plate  12  is interrupted by two spring-like, cantilevered polygonal tabs PT 1  and PT 2 , spaced about 90° apart from each other at approximately nine o′clock and six o′clock, respectively, in  FIG. 2 . Cantilevered polygonal tabs PT 1  and PT 2  each have a V-shaped projection protruding radially outwardly from an inner rectangular portion of the tabs. The V-shaped projections are indexer tabs that operate as spring fingers to snap into and out of mating female V-shaped grooves G located on the inner surface of the innermost ring IR of adjuster ring  14  ( FIG. 3 ). The operation and purpose of the V-shaped projections and grooves G are discussed in more detail below. 
     Base plate  12  of  FIG. 2  also illustrates an inner ring  12   a  has four longitudinally extending semi-cylindrical tabs LT 1  to LT 4 . Longitudinally extending tabs LT 1  to LT 4  of base plate  12  extend through semi-cylindrical apertures A 1  to A 4 , respectively, formed in top plate  16  shown in  FIG. 4  (only three apertures A 1 , A 2  and A 4  are visible in  FIG. 4 ). Likewise, polygonal tabs PT 1  and PT 2  of base plate  12  extend into polygonal, five-sided holes PH 1  and PH 2 , respectively, formed in the top plate  16 . 
     When adjustable pad  10  is fully contracted, such that base plate  12  sits as deep as possible into top plate, semi-cylindrical or arched apertures A 1  to A 4  allow the like-shaped longitudinally extending tabs LT 1  to LT 4  to extend respectively through apertures A 1  to A 4  and outwardly past the predominantly solid outer surface  16   a  of top plate  16 . Likewise, polygonal tabs PT 1  and PT 2  are allowed to extend through polygonal holes PH 1  and PH 2  and outwardly past the predominantly solid outer surface  16   a  of top plate  16 . Polygonal holes PH 1  and PH 2  are oversized as needed to allow polygonal tabs PT 1  and PT 2  to flex radially back and forth within polygonal holes PH 1  and PH 2 . The distal portions of each of the tabs LT 1  to LT 4 , PT 1  and PT 2  extending past the solid outer surface  16   a  of top plate  16  are covered by the felt cushion attached to hook sheet  18  and thus are not felt or sensed by the patient. 
     On the other hand, when adjustable pad  10  is fully telescoped and expanded, longitudinally extending tabs LT 1  to LT 4  of base plate  12  even though removed from apertures A 1  to A 4  of top plate  16  are still able to maintain sliding contact with the outer surfaces of centrally located semi-cylindrical tabs CT 1  and CT 2  extending longitudinally inwardly within top plate  16 . The sliding contact between the inside surfaces of longitudinally extending tabs LT 1  to LT 4  of base plate  12  and the outer surfaces of semi-cylindrical tabs CT 1  and CT 2  of top plate  16  throughout the entire range of motion for adjustable pad  10  is accordingly achieved, provides stability and protects against top plate  16  and base plate  12  tilting against each other during adjustment. 
     Base plate  12  of  FIG. 2  is also illustrated as having six spring-like, cantilevered fingers F 1  to F 6  along its outer wall  12   c  that are bent slightly as the fingers slide along respectively slots S 1  to S 6  formed on an inner surface of sidewall  16   b  in top plate  16  of  FIG. 4 . The tops of fingers F 1  to F 6  each include outwardly projecting lips  12   d  that mate with and are pushed by the walls of slots S 1  to S 2 . Apertures  16   c  are provided in solid outer surface  16   a  of top plate  16  located at the end of each slot S 1  to S 6 , so that fingers F 1  to F 6  can travel into slots S 1  to S 6  if need be to prevent fingers F 1  to F 6  from bottoming out against outer surface  16   a . The felt cushion attached to sheet  18  shown in  FIG. 1  again covers the projecting lips  12   d , so that the lips do not impact the user. The fitting of fingers lips F 1  to F 6  into respective slots/apertures S 1  to S 6   16   c  also provides (i) rotational stability of base plate  12  relative to top plate  16  and (ii) additional tilting stability of the base plate relative to the top plate. 
     The innermost rings  12   a  and CT 1 /CT 2  of base plate  12  and top plate  16 , respectively, each include matching openings O 1  and O 2  that allow for the small extension springs  22  shown in  FIGS. 1 ,  5 A,  5 B and  6  to mount, each on one spring  22  end to a mounting hole MH 1  or MH 2  of the solid outer surface  16   a  of top plate  16  and to extend to connect each on their opposing spring  22  end to a rod  24  carried by base plate  12 , which is also shown in  FIGS. 1 ,  5 A and  5 B. Springs  22  can be metal or plastic and in an embodiment include a hook at both ends to releasably latch onto mounting holes MH 1  and MH 2  or rod  24 . Rod  24  can also be metal or plastic and releasably sits in tubular end supports ES 1  and ES 2  ( FIGS. 2 and 5A ) located in the solid wall of base plate  12 . Rod  24  extends across the central opening in the solid wall of base plate  12  from end support ES 1  to end support ES 2 . The exposed portion of rod  24  accepts the opposing ends of extension springs  22 . Extension springs  22  pull base plate  12  and top plate together against adjuster ring  14  of  FIG. 3  regardless of the translational position of base plate  12  relative to top plate  16 . 
     Base plate  12  does not rotate relative to top plate  16 . The plates instead translate away from or towards each other, such that adjustable pad  10  either expands or contracts. Adjuster ring  14  of  FIG. 3  on the other hand rotates relative to both base plate  12  and top plate  16 . As shown in the views of  FIGS. 2 to 4 , adjuster ring  14  sits as it is shown in  FIG. 3  with its handle H forming an upwards “U” shape when adjuster ring  14  is placed in base plate  12  and base plate  12  is oriented as it is shown in  FIG. 2 . Top plate  16  is then turned upside down relative to its position of  FIG. 4  (so that S 1  and S 6  match F 1  and F 6 ) to fit over the adjuster ring  14  sitting in base plate  12 . 
     Adjuster ring  14  as illustrated in  FIG. 3  includes an inner ring IR, an outer ring OR and spokes SP 1  to SP 4  extending between the rings. Spokes SP 1  to SP 4  each have slight positively or outwardly pointing ramp angles on both top and bottom sides of each spoke. That is, the spokes form slightly angled rooftop type shapes on both the upper and lower sides of adjuster ring  14  shown in  FIG. 3 . The slight positively or outwardly pointing ramp angles of spokes SP 1  to SP 4  mate with any one of five mating negatively or inwardly pointing ramp angles RA 1  to RA 5  of a respective inclined ramps R 1  to R 4 . That is, ramp angles RA 1  to RA 5  are indented, forming a flatly angled V-shape. Ramps R 1  to R 4  are provided on both base plate  12  and top plate  16 . Each of ramps R 1  to R 4  has the five ramp angles RA 1  to RA 5 . Each ramp angle RA 1  to RA 5  (i) extends along an incline of the ramp so as to have a different distance from a foot of the ramp than does an adjacent ramp angle and (ii) corresponds to one of the five telescoping expansion/compression settings of adjustable pad  10 . 
     Each of the five expansion/compression settings of adjustable pad  10  is provided on label  15  (shown in  FIGS. 1 ,  5 A,  5 B and  7 ) attached to top plate  16 . The numbers on the illustrated label correspond to millimeters of adjustment. The lowest number is 4 millimeters (“mm”), which represents the initial starting height of pad  10 . There are five positions in the illustrated embodiment, which as illustrated are: 4 mm, 6 mm, 8 mm, 10 mm, and 12 mm. These numbers correspond roughly to 3°, 4.5°, 6°, 7.5°, and 9° of knee compartment correction, respectively. The settings could vary as desired and more or less than five settings could be provided alternatively. 
     The most compressed position of base plate  12  relative to top plate  16  occurs when adjuster ring  14  is rotated such that all four of its spokes S 1  to S 4  sit between ramp angles RA 1  of each of mating base plate  12  side and top plate  16  side ramps R 1 /R 1 , R 2 /R 2 , R 3 /R 3  and R 4 /R 4 . The second most compressed position of base plate  12  relative to top plate  16  occurs when adjuster ring  14  is rotated such that all four of its spokes SP 1  to SP 4  sit between ramp angles RA 2  of each of mating ramps R 1 /R 1 , R 2 /R 2 , R 3 /R 3  and R 4 /R 4 , and so on. Thus, the most expanded position of base plate  12  relative to top plate  16  occurs when adjuster ring  14  is rotated such that all four of its spokes S 1  to S 4  sit between ramp angles RA 5  of each of mating ramps R 1 /R 1 , R 2 /R 2 , R 3 /R 3  and R 4 /R 4 . 
     The two springs  22  discussed above hold ramps R 1  to R 4  sandwiched against spokes SP 1  to SP 4  of adjuster ring  14 . The relatively small springs  22 , the relatively slight angles of spokes SP 1  to SP 4 , and the relatively sight angles of mating the ramp angles RA 1  to RA 5  are not required to hold adjuster ring  14  releasably locked to any of the expansion/compression settings. Additionally, as described above, polygonal spring tabs PT 1  and PT 2  are provided to lock releasably each into one of the five grooves G provided on the inside of the inner ring IR of adjuster ring  14 . Thus each of the five grooves G also corresponds to one of the five expansion/compression settings of adjustable pad  10  device provided on the label. The relatively steep, e.g., 45°, ramp angles of the positively or outwardly angled polygonal spring tabs PT 1  and PT 2  and mating inwardly angled grooves G provide a good locking force but on the other hand do not require undue force to index adjuster ring  14 . 
       FIG. 5A  shows the assembled adjustable pad  10  in its most compressed position from the base plate  12  side of pad  10 . Pile layer  20  has been removed to show additional detail on plate  12 . Top plate  16  extends past the mated base plate such that a lip L forms around the periphery of this brace hinge mating side of adjustable pad  10 . The lip L fits around the periphery of hinge  32  of the knee brace  30  as shown below in  FIG. 7 . Lip L provides mounting stability to the removeable attachment of pad  10  to hinge  32 . For example, lip L makes the twisting of pad  10  relative to hinge  32  difficult, helping to prevent pad  10  from twisting off of hinge  32  and brace  30  by accident. Again, hinge  32  is provided with a hook material that attaches releasably to the pile material provided on base pile layer  20  ( FIGS. 1 and 7 ) adhered to the face of base plate  12 . A foam cushion  19  is removably attached to hook sheet  18  ( FIGS. 1 and 5B ) on the opposing side of pad  10 . Foam cushion  19  provides a softened interface with the patient&#39;s knee. 
     As illustrated in  FIGS. 4 ,  5 A and  5 B, notch N provided in sidewall  16   b  of top plate  16  allows handle H to travel back and forth to different height adjustment settings for adjustable pad  10 . Notch N also provides end of travel stops at the lowest height setting and the largest height setting so that adjuster  14  cannot be moved or rotated any further, which would potentially cause spokes SP 1  to SP 4  to slip onto a different ramp, e.g., from a largest height setting of the correct ramp immediately to the lowest height setting of an adjacent ramp. 
       FIG. 5B  shows the assembled adjustable pad  10  from the top plate  16  side of the pad. Hook sheet  18  is shown having a hook material hatch.  FIG. 5B  illustrates certain features of top plate  16  that are more difficult to see in  FIGS. 1 and 4 , which also illustrate top plate  16 .  FIG. 5B  shows setting label  15  of base plate  12  and handle H of adjuster ring  14 . Also illustrated from base plate  12  are spring tip lips  12   d  of spring-like cantilevered fingers F 1  to F 6 . Lips  12   d  are illustrated as just meeting or slightly inserted through mating aperture  16   c  of slots S 1  to S 6  formed along the inside of sidewall  16   b  of top plate  16 . If it is desired to remove top plate  16  from base plate  12 , springs  22  are unhooked from rod  24 . 
     As discussed above, outer surface  16   a  of top plate  16  (as shown in FIG.  1 —needs to be labeled in  FIG. 5B ) of  FIG. 5B  defines semi-cylindrical apertures A 1  to A 4 , which respectively accept longitudinally extending tabs LT 1  to LT 4  as the tabs are translated outwardly or inwardly via the ramp angle settings RA 1  to RA 5 . Likewise, polygonal holes PH 1  and PH 2  formed in outer surface  16   a  of top plate  16  receive polygonal tabs PT 1  and PT 2 , respectively, as the tabs are translated outwardly and inwardly via ramp angle settings RA 1  to RA 5 . The engagement of base plate  12  and top plate  16  via each of (i) spring fingers F 1  to F 6 , (ii) longitudinally extending tabs LT 1  to LT 4  and (iii) polygonal tabs PT 1  and PT 2  constrains base plate  12  and top plate  16  from rotating or tilting relative to each other as the plates are translated together and apart via ramp angle settings RA 1  to RA 5 . The four spokes and sets of ramp angles also provide an evenly distributed force around the circumference of pad  10 . 
       FIG. 5B  also illustrates spring mounting holes MH 1  and MH 2  defined by outer surface  16 A of top plate  16 . Spring mount holes MH 1  and MH 2  each accept one end of two extension springs  22 . The other ends of springs  22  hook or otherwise attach to metal or plastic rod  24  positioned in base plate  12 . As discussed above, springs  22  compresses base and top plates  12  and  16  to adjuster ring  14  throughout the movement of spokes SP 1  to SP 4  through ramps R 1  to R 4  of both base and top plates  12  and  16 . 
     While adjustable pad  10  has been illustrated with angled ramps R 1  to R 4  on both base and top plates  12  and  16 , it is contemplated in an alternative embodiment to provide ramps R 1  to R 4  having ramp angles, such as ramp angles RA 1  to RA 5 , on only one of base plate  12  and top plate  16 . The other plate could have non-changing, constant height semi-cylindrical ridges instead of angled semi-cylindrical ramps R 1  to R 4 , or have no ridges at all. Further, for any embodiment of pad  10 , more or less than four ramps may be provided. 
     Referring now to  FIG. 6 , a simplified sectioned view of adjustable pad  10  is illustrated.  FIG. 6  is not meant to replicate the structures of  FIGS. 1 to 5 . Instead,  FIG. 6  is intended to illustrate the movement and the holding together of pad  10  in a more simplified manner.  FIG. 6  also shows base plate  12 , adjuster ring  14  and top plate  16  fastened together in a sectioned view, which is helpful (note that in reality the two ramps actually slide past one another when they are completely telescoped closed). 
     Base plate  12  illustrates ramp angles RA 1  to RA 5 , which can be of any of the orthogonally spaced apart ramps R 1  to R 4  of the base plate. Likewise, top plate  16  illustrates mating ramp angles RA 1  to RA 5 , which can again be of any of the orthogonally spaced apart ramps R 1  to R 4  of the top plate. Base plate  12  is also illustrated with fingers F 1  to F 6  as described above. Base plate  12  and top plate  16  are both illustrated accepting springs  22 . While the actual configuration and placement of springs  22  may be different than is shown in  FIG. 6 , the function and purpose of the springs is conveyed. 
     The upper and lower positive or outwardly projection rooftop ramp angles or spokes SP 1  to SP 4  on the upper and lower surface of spokes SP 1  to SP 4  engage the negative or V-shaped indentations RA 1  to RA 5  of ramps R 1  to R 4 . As spoke SP 1  to SP 4  is pushed left to right in  FIG. 6 , springs  22  and spring, fingers F 1  to F 6 , and polygonal tabs PT 1  and PT 2  cause the user to feel a resistance as the spoke moves to the next position. Eventually, at the next position, plates  12  and  16  snap together as the greatest height of the cross-section of the spoke moves past the most pinched together opening of the adjacent mated ramp angles. Springs  22  keep compression on the assembly of plates  12  and  16  and adjuster ring  14 . 
     In  FIG. 6 , spoke SP 1  to SP 4  is shown positioned at the middle adjustment location between ramp angles RA 3  of plates  12  and  16 . The collective height of any given adjustment location is the sum of the height of spoke SP 1  to SP 4  plus the distances of the mated ramp angles to their respective top and bottom of the top and base plates  16  and  12 . Thus if spoke SP 1  to SP 4  is moved to the right between ramp angle RA 4 , the overall telescoping height of the adjuster  10  increases because the distances between ramp angles RA 4  to top and bottom of respective plates  16  and  12  increases relative to that of mated ramp angles RA 3 . Conversely, if spoke SP 1  to SP 4  is moved one position to the left, to mated ramp angles RA 2 , the overall telescoping height of adjuster  10  decreases because the distances between ramp angles RA 2  to the top and bottom of respective plates  16  and  12  decreases relative to that of mated ramp angles RA 3 . Springs  22  compress accordingly to maintain pressure on the ramp and spoke assembly. 
     It should be appreciated therefore that mated ramp angles RA 1  yield the least telescoped overall height, while mated ramp angles RA 5  yield the greatest telescoped overall height of adjuster  10 . Springs  22  maintain compression on the assembled adjuster pad  10  regardless of the mated ramp angle location RA 1  to RA 5  to which spoke SP 1  to SP 4  has been rotated. 
     As shown in  FIG. 7 , adjustable pad  10  is placed removably by the user on the inside of one hinge  32  of the brace  30 . Pad  10  pushes up against one side or the other side of user&#39;s knee. A felt cushion  19  is provided on the inside of pad  10  to make comfortable contact with the user&#39;s knee. Most of the time, adjustable pad  10  is positioned at the lateral or outer side of the user&#39;s knee because the majority of knee problems are medial (inner) condyle compartment or medial osteoarthritis, requiring adjustable pad  10  to push the knee inward. A small percentage of patients have problems with the lateral (outer) condyle compartment. Here, adjustable pad  10  is switched to the other side of the knee brace and is worn such that adjustable pad  10  is located on the inside of the patient&#39;s knee to push outwardly on the patient&#39;s knee, thus opening the lateral compartment. 
     Second Primary Embodiment 
     A second primary embodiment for an adjustable pad is shown and described in connection with adjustable pad  110  and  FIGS. 8 to 11  as follows.  FIG. 8  is an exploded view showing the different pieces of adjustable pad  110 .  FIG. 8  in general flows oppositely from the flow of  FIG. 1 . That is, from left to right, adjustable pad  10  in  FIG. 1  flows from the side of the pad that abuts the wearer&#39;s knee to the side of the pad that attaches to the knee brace. In  FIG. 8 , adjustable pad  110  flows left to right instead from the side of the pad that attaches to the knee brace to the side of the pad that abuts the wearer&#39;s knee. 
     From left to right, adjustable pad  110  includes a mounting screw or fastener  124 , a pressure-applying washer  126 , a compression spring  122 , a base hook or pile layer  120 , a base plate  112 , an adjuster ring  114 , a label  115 , a threaded mounting insert  128 , a top plate  116 , a top plate pile or hook sheet  118 , a pad hook or pile layer  117 , and a cushioned pad  119 . As mentioned above, for any embodiment of the adjustable pads of the present disclosure, any surface can have hook or pile material interchangeably. 
     Mounting screw or fastener  124  can be a metal, e.g., steel or stainless steel, screw, such as a flathead screw. Pressure-applying washer  126  can likewise be metal, e.g., steel or stainless steel, and in an embodiment is formed with a chamfered hole that allows the flathead of screw  124  to sit flush with the outer surface of pressure-applying washer  126 . Threaded mounting insert  128  can likewise be made of metal, e.g., steel or stainless steel, or be made of a hard plastic. 
     Base hook or pile layer  120  is applied to, e.g., adhered to, outer surface  112   a  of base plate  112 . Top plate pile or hook sheet  118  is applied to, e.g., adhered to, the outer surface of top plate  116 . Pad hook or pile layer  117  is applied to, e.g., adhered to, an inner surface  119   a  of cushioned pad  119 . Adjustable pad  110  is removably attached to hinge  32  of brace  30  via a hook and pile attachment with hook or pile layer  120 . Cushioned pad  119  is removably attached to top plate  116  for cushioned contact with the side of a user&#39;s knee via a hook and pile attachment between top plate pile or hook sheet  118  and pad hook or pile layer  117 . Label  115  can be attached to, e.g., adhered to, any of base plate  112 , adjuster ring  114  (discussed in more detail below) or top plate  116 . Label  115  can include the same or different, more or less, demarcations as label  15  discussed above. Base plate  112 , adjuster  114  and top plate  116  can be metal or plastic, e.g., molded plastic, and be made of any of the materials discussed above for base plate  12 , adjuster  14  and top plate  16 . 
     Threaded mounting insert  128  is molded into or press-fit into a central aperture  116   a  formed in top plate  116 . Base end  128   a  of threaded mounting insert  128  is female threaded to threadingly receive screw  124 . Top end  128   b  of threaded mounting insert  128  can be blind or solid to provide a hard stop for screw  124 . Or, aperture  116   a  can be a blind aperture and provide a hard stop for screw  124 , allowing insert  128  to be open on both ends  128   a  and  128   b . Screw  124  can be glued into place within threaded mounting insert  128 . Alternatively, threaded mounting insert  128  can be lined with a self-locking liner, such as a nylon liner used with self-locking nuts or aircraft type nuts. Insert  128  can have a portion that extends out from aperture  116   a  or be fully inserted into aperture  116   a , such that base end  128   a  is at least substantially flush with aperture  116   a.    
     With threaded mounting insert  128  fixed to top plate  116 , screw  124  extends through pressure-applying washer  126 , spring  122 , base plate  112  and adjuster ring  114  and fastens to threaded base end  128   a  of threaded mounting insert  128 , capturing pressure-applying washer  126 , spring  122 , base plate  112 , adjuster ring  114  and top plate  116  together forming an assembled adjustable pad  110 . Screw  124  in this manner holds adjustable pad  110  together. 
     Spring  122  is compressed between washer  126  and an offset surface  112   b  of base plate  112 . In this configuration, compression spring  122  presses base plate  112 , adjuster ring  114 , and top plate  116  together for operation. When spring  122  is fully compressed, assembled adjustable pad  110  cannot be further expanded. The most expanded setting along label  15  is therefore configured to occur before spring  122  is fully compressed. 
     When adjustable pad  110  is in its most compressed state, spring  122  is in its most expanded state but is still compressed enough to apply a suitable holding force to hold base plate  112 , adjuster ring  114 , and top plate  116  together for operation. Here, the head of screw  124  may extend out past outer surface  112   a  and hook or pile layer  120 . Hinge  32  of brace  30  can have a natural recess or open area for accepting the extended head of screw  124 , so that the screw does not interfere with the hook and pile attachment between adjustable pad  110  and hinge  32 . Alternatively, the amount that surface  112   b  is offset from outer surface  112   a  of base plate  112  and/or the length of screw  124  are selected so that the head of screw  124  does not extend outwardly past outer surface  112   a  and hook or pile layer  120  regardless of how compressed adjustable pad  110  becomes. 
     Top plate  116  includes receiver posts  116   b  that extend towards base plate  112 . Receiver posts  116   b  receive mating studs  112   c  ( FIG. 10 ) extending from an inside of base plate  112  towards top plate  116 . The mating of receiver posts  116   b  and studs  112   c  provides adjustable pad  110  with the rotational and tilt stability as has been discussed above for adjustable pad  10 . More than two receiver posts  116   b  and mating studs  112   c  can be provided alternatively to help prevent the tilting and rotating of top plate  116  relative to base plate  112 . Receiver posts  116   b  can lead to openings in the top wall of top plate  116  or studs  112   c  can be short enough such that the studs do not bottom out against the inside of the top wall of top plate  116  even when adjustable pad  110  is fully compressed. As with pad  10 , cushioned pad  119  will negate any user detection or feeling of studs  112   c  if the studs extend out past the top wall of top plate  116 . 
     Adjuster ring  114  includes a handle  114   a  that enables the user to grasp and turn adjuster ring  114 . While adjusters  14  and  114  have been described as rings, it should be appreciated that the adjusters could alternatively be linearly actuated adjusters and therefore do not have to be adjuster rings. 
     Referring now to  FIG. 9 , adjuster  114  is illustrated in more detail. With pad  10 , ramps R 1  to R 4  are provided on one or both of base plate  12  and top plate  16 , while spokes SP 1  to SP 4  are provided on adjuster  14 . With pad  110  on the other hand, a plurality of ramps are provided instead on one or both sides of adjuster  114 . Adjuster  114  includes four ramps R 1  to R 4  as before, each ramp including five ramp angles RA 1  to RA 5 . Adjuster  114  can alternatively include more or less ramps having more or less ramp angles. While ramps R 1  to R 4  can be provided on one or both sides of adjuster  114 , in the illustrated embodiment, ramps R 1  to R 4  are provided only on the side of adjuster  114  that faces base plate  112 . 
     Adjuster  114  also includes or defines a notch  114   b  that receives a head portion  115   a  of label  115 . Notch  114   b  helps to hold and orient label for connection to adjuster  114 . With adjustable pad  10 , the handle H moved relative to stationary label  15 . In the illustrated embodiment of adjustable pad  110 , label  115  moves along with handle  114   a . Base plate  112  and/or top plate  116  therefore need only provide a mark that aligns with one of the moveable indicia of label  115  to indicate a current height setting. 
       FIG. 9  also illustrates that adjuster  114  includes an inner tubular collar  114   c  including or providing a plurality of inwardly disposed V-shaped grooves G. In the illustrated embodiment, V-shaped grooves G span the entire three-hundred sixty degree inner circumference of inner tubular collar  114   c.    
     Referring now to  FIG. 10 , the side of base plate  112  that mates with ramps R 1  to R 4  of adjuster  114  is illustrated. Offset surface  112   b  of base plate  112  described above for receiving and interacting with spring  122  is illustrated. Offset surface  112   b  also defines a central hole for receiving screw  124 . Alignment studs  112   c  discussed above for insertion into receiver posts  116   b  of top plate  116  for tilt and rotational stability are also illustrated. 
     Base plate  112  includes a spoke ring  112   d  that provides structural rigidity to base plate  112  itself as well as to spokes SP 1  to SP 4  connected at their inner ends to spoke ring  112   d . Spokes SP 1  to SP 4  are paddle shaped as opposed to the ramped or double-ramped polygonal shapes of spokes SP 1  to SP 4  of adjustable pad  10 . Paddle shaped spokes SP 1  to SP 4  are slender and rounded along their surfaces for interacting with ramp angles RA 1  to RA 5  and are thus readily able to snap fit into the female V-shaped grooves of the ramp angles. As before, each ramp angle RA 1  to RA 5  extends along an incline of the ramp so as to have a different distance from a foot of the ramp than does an adjacent ramp angle. In the illustrate embodiment, like above with adjustable pad  10 , spoke SP 1  of base plate  112  is dedicated to ramp R 1  of adjuster  114 , spoke SP 2  of base plate  112  is dedicated to ramp R 2  of adjuster  114 , spoke SP 3  of base plate  112  is dedicated to ramp R 3  of adjuster  114 , and spoke SP 4  of base plate  112  is dedicated to ramp R 4  of adjuster  114 . 
     Spokes SP 1  to SP 4  ride along the changing height of ramp angles RA 1  to RA 5  of ramps R 1  to R 5 , respectively, changing the overall height in the manner illustrated in connection with  FIG. 6 . Here, as opposed to  FIG. 6 , only one set of ramps R 1  to R 4  is provided. Nevertheless, the mode of changing the height of adjustable pad  110  is aptly illustrated by  FIG. 6 . And as has been described, spring  122  holds spokes SP 1  to SP 4  to ramps R 1  to R 4 , respectively, regardless of which ramp angle RA 1  to RA 5  is selected and applied. 
     Referring additionally to  FIG. 8 , top piece  116  provides radially extending paddles  116   c . Paddles  116   c  could be modified to be spokes that operate with a second set of ramps extending from adjuster  114  towards top plate  116 . In the illustrated embodiment, however, radially extending paddles  116   c  serve to provide rigidity to top plate  116  and to space or center adjuster  114  within top plate  116  for proper operation. Top plate also includes or defines a notch  116   d  that limits the travel of handle  114   a  and adjuster  114  about base plate  112  and top plate  116 , maintaining lining a set relationship between spokes SP 1  to SP 4  and respective ramps R 1  to R 4  as has been described with notch N of adjustable pad  10 . 
       FIG. 10  also shows that top piece  116  includes or defines polygonal tabs PT 1  and PT 2  that serve largely the same purpose as the polygonal tabs PT 1  and PT 2  of adjustable pad  10 . Polygonal tabs PT 1  and PT 2  of top plate  116  are spring-like and include outwardly facing triangular shapes that bendingly snap-fit into mating contact with multiple ones of V-shaped grooves G spanning the circumference of inner tubular collar  114   c  of adjuster  114 . The snap-fitting connection between polygonal tabs PT 1  and PT 2  and grooves G provides tactile feedback to the user. The snap-fitting connection also holds adjustable pad  110  in a desired telescoped height setting. 
     The many V-shaped grooves G can provide a finer amount of adjustability than do the five ramp angle setting shown above. That is, a ramp angle could be provided for each groove G per ramp R 1  to R 4 . Thus if there are twelve grooves G per ramp R 1  to R 4 , there could be twelve ramp angles RA 1  to RA 12 . The four mm to twelve mm pad height adjustment discussed above could be divided into twelve setting instead of the five shown above. Or, the height adjustment range could be expanded over the twelve settings, e.g., four mm to 12.25 mm over 0.75 mm increments, or four mm to fifteen mm over 1.00 mm increments. There can also be more or less than twelve grooves G per ramp. In any case, the grooves G and polygonal tables PT 1  to . . . PTn hold adjuster  114  and adjustable pad  110  in a set position until modified by the user. 
     Referring now to  FIG. 11 , an assembled adjustable pad  110  is illustrated. Base hook or pile layer  120  is exposed so that pad  110  can be removably attached to hinge  32  of brace  30 . Screw  124  is shown being flush with press-applying washer  126 , both of which are in turn substantially flush with base plate  112 . Base plate  112  could be pushed inwardly from screw  124  and washer  126 , in which case screw  124  and washer  126  can reside inside a recess of hinge  32 , allowing base hook or pile layer  120  to be fastened to the mating pile or hook material of brace hinge  32 . Gel cushioned and/or foam padding cushioned pad  119  is removably fastened to adjustable pad  110  for cushioned impact with the side of the user&#39;s knee. Handle  114   c  is available to be rotatably pushed or pulled to change a height adjustment setting. 
     Associated Methodology 
     As mentioned in the SUMMARY, the apparatuses of the present disclosure operate via methods to provide a varied amount of side load on a user&#39;s knee. The method includes enabling a user to turn or maneuver a handle provided by a removable telescoping pad that can be placed on the medial or lateral side of a user&#39;s knee. The handle moves or turns a structure, such as an adjustable ring. The ring can have a spoke for example. The turning of the causes the ring, e.g., spoke, to wedge into a new set of features, e.g., ramp angles, provided by first and second plates surrounding the adjustable ring. The wedging of the ring into the new set of features causes a telescoping expansion or compression of the assembly to apply a changed side load to the knee. A spring compression force is supplied to compress the plates to the adjustable ring during adjustment or changing of the wedge. 
     In the above method, the ramp angles and associate ramps are provided on one or both sides of the adjuster ring, either physically on the plates or on the adjuster itself, while the spokes or other ramp angle mating features are provided alternatively on the adjuster or on one or both of the mating first and second plates. As shown above, the spring can be an extension spring that is pulled apart and is biased to compress back to its natural shape to provide the compressive force. The spring can alternatively be a compression spring that is pushed together and is biased to expand back its natural shape to provide the compressive force. 
     It should be understood that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. For example, many features of the top plate could be provided instead on the base plate and vice versa. This is reflected below in the claims. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.