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                                                                    EXHIBIT 4.18


                                                      AMENDED AND RESTATED
                                            PLEDGE AGREEMENT dated as of June
                                            28, 2000, between MICHAEL R.
                                            MCBRAYER (the "Pledgor"), and
                                            DONJOY, L.L.C., a Delaware limited
                                            liability company (the "Company").

               The Company and the Pledgor are parties to a Pledge Agreement
dated as of June 30, 1999 (the "Existing Pledge Agreement"), whereby the Pledgor
pledged to the Company 3,000 Common Units of the Company (the "Initial Pledged
Securities") as security for the Pledgor's due and punctual payment and
performance of his obligations under the promissory note dated as of June 30,
1999 in the aggregate principal amount of $200,000 issued by the Pledgor in
favor of the Company in partial payment for the purchase price of the Initial
Pledged Securities (the "Initial Note"). On the date hereof, the Pledgor, with
the consent of the Company, has amended and restated the Initial Note (as so
amended and restated, and as further amended, supplemented, restated or
otherwise modified from time to time in accordance with its terms, the "Amended
Note") to, among other things, (i) add the accrued and unpaid interest on the
Initial Note on the date hereof ($10,541.11) to the unpaid principal amount of
the Initial Note on the date hereof ($200,000) and (ii) permit the Pledgor to
elect, on any date on which a payment of interest on the Initial Note is
scheduled to be made, to increase the unpaid principal amount of the Initial
Note by the amount of such interest in lieu of the payment thereof.

               The Pledgor now proposes to purchase 244 Common Units of the
Company (the "Additional Pledged Securities"; and together with the Initial
Pledged Securities, the "Pledged Securities") from Smith & Nephew Disposal, Inc.
("S&N"), pursuant to a certain Unit Purchase Agreement dated as of the date
hereof, among S&N, the Pledgor and certain other members of the Company. In
order to fund a portion of the aggregate purchase price being paid by the
Pledgor for the Additional Pledged Securities, the Pledgor desires to borrow
$17,728.91 (the "Additional Loan") from the Company, against the issuance by the
Pledgor in favor of the Company of a promissory note dated as of the date hereof
in the aggregate principal amount of the Additional Loan (as amended,
supplemented, restated or otherwise modified from time to time in accordance
with its terms, the "Additional Note"; and together with the Amended Note, the
"Notes").

               As a material inducement to the Company to make the Additional
Loan, the Pledgor has agreed with the Company to amend and restate the Existing
Pledge Agreement to provide for the Pledgor's pledge of the Pledged Securities
to the Company as security for his due and punctual payment and performance of
his obligations under each of the Notes and the Existing Pledge Agreement. This
Agreement shall amend and restate the Existing Pledge Agreement in its entirety
as and pursuant to this Agreement.

               ACCORDINGLY, in consideration of the foregoing premises and the
mutual covenants and agreements herein contained and for other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the
parties hereto hereby agree as follows:



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        SECTION 1. PLEDGE.

               The Pledgor hereby pledges to the Company, and grants to the
Company a security interest in, the Pledged Securities as security for the
prompt and complete payment when due of the unpaid principal and of interest on
each of the Notes.

        SECTION 2. DELIVERY OF PLEDGED SECURITIES.

               The Pledgor confirms that he has previously delivered to the
Company certificates representing the Initial Pledged Securities, together with
duly executed forms of assignment sufficient to transfer title thereto to the
Company.

               Upon the execution of this Agreement, the Pledgor shall deliver
to the Company the certificates representing the Additional Pledged Securities,
together with duly executed forms of assignment sufficient to transfer title
thereto to the Company.

        SECTION 3. VOTING RIGHTS; CASH DISTRIBUTIONS.

               Notwithstanding anything to the contrary contained herein, during
the term of this Agreement until such time as there exists a default in the
payment of principal or interest on either Note or any other default under
either Note, the Pledgor shall be entitled to all voting rights with respect to
the Pledged Securities and shall be entitled to receive all cash distributions
paid in respect of the Pledged Securities. Upon the occurrence of and during the
continuance of any such default, the Company shall retain all such cash
distributions payable on the Pledged Securities as additional security
hereunder.

        SECTION 4. STOCK DIVIDENDS; DISTRIBUTIONS ETC.

               If, while this Agreement is in effect, the Pledgor becomes
entitled to receive or receives any securities or other property in addition to,
in substitution of, or in exchange for any of the Pledged Securities (whether as
a distribution in connection with any recapitalization, reorganization or
reclassification, distributions or otherwise), the Pledgor shall accept such
securities or other property on behalf of and for the benefit of the Company as
additional security for the Pledgor's obligations under the Notes and shall
promptly deliver such additional security to the Company together with duly
executed forms of assignment, and such additional security shall be deemed to be
part of the Pledged Securities hereunder.

        SECTION 5. DEFAULT.

               If the Pledgor defaults in the payment of the principal or
interest under either Note as it becomes due (whether upon demand, acceleration
or otherwise) or any other event of default under either Note occurs and has not
been remedied within the 10 day period provided in Section 3(a)(i) of such Note
(including the bankruptcy or insolvency of the Pledgor) (each such occurrence
shall be deemed a "Default"), the Company may exercise any and all of the
rights, powers and remedies of an owner of the Pledged Securities (including the
right to vote the shares and receive dividends and distributions with respect to
such shares) and shall have and may exercise without demand any and all the
rights and remedies granted to a secured party upon default under the Uniform
Commercial Code of the State of New York or otherwise available to



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the Company under applicable law. Without limiting the foregoing, if the Pledgor
Defaults, the Company is authorized to sell, assign and deliver at its
discretion, from time to time, all or any part of the Pledged Securities at any
private sale or public auction, on not less than ten days written notice to the
Pledgor, at such price or prices and upon such terms as the Company may deem
advisable. The Pledgor shall have no right to redeem the Pledged Securities
after any such sale or assignment. At any such sale or auction, the Company or
any other holder of Units of the Company may bid for, and become the purchaser
of, the whole or any part of the Pledged Securities offered for sale. In case of
any such sale, after deducting the costs, attorneys' fees and other expenses of
sale and delivery, the remaining proceeds of such sale shall be applied to the
principal of and accrued interest on each Note; provided, however, that after
payment in full of the indebtedness evidenced by each Note, the balance of the
proceeds of sale then remaining shall be paid to the Pledgor and the Pledgor
shall be entitled to the return of any of the Pledged Securities remaining in
the hands of the Company. The Pledgor shall be liable for any deficiency if the
remaining proceeds are insufficient to pay the indebtedness under each Note in
full, including the fees of any attorneys employed by the Company to collect
such deficiency.

        SECTION 6.  COSTS AND ATTORNEYS' FEES.

               All costs and expenses, including reasonable attorneys' fees,
incurred in exercising any right, power or remedy conferred by this Agreement or
in the enforcement thereof, shall become part of the indebtedness secured
hereunder and shall be paid by the Pledgor or repaid from the proceeds of the
sale of the Pledged Securities hereunder.

        SECTION 7.  PAYMENT OF INDEBTEDNESS AND RELEASE OF PLEDGED SECURITIES.

               Upon payment in full of the indebtedness evidenced by each Note,
the Company shall surrender the Pledged Securities to the Pledgor together with
all forms of assignment.

        SECTION 8.  FURTHER ASSURANCES.

               The Pledgor agrees that at any time and from time to time upon
the written request of the Company, the Pledgor will execute and deliver such
further documents and do such further acts and things as the Company may
reasonably request in order to effect the purposes of this Agreement.

        SECTION 9.  SEVERABILITY.

               Any provision of this Agreement which is prohibited or
unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective
to the extent of such prohibition or unenforceability without invalidating the
remaining provisions hereof, and any such prohibition or unenforceability in any
jurisdiction shall not invalidate or render unenforceable such provision in any
other jurisdiction.

        SECTION 10. NO WAIVER; CUMULATIVE REMEDIES.

The Company shall not by any act, delay, omission or otherwise be deemed to have
waived any of its rights or remedies hereunder, and no waiver shall be valid
unless in writing, signed by the Company, and then only to the extent therein
set forth. A waiver by the



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Company of any right or remedy hereunder on any one occasion shall not be
construed as a bar to any right or remedy which the Company would otherwise have
on any future occasion. No failure to exercise nor any delay in exercising on
the part of the Company, any right, power or privilege hereunder shall preclude
any other or further exercise thereof or the exercise of any other right, power
or privilege. The rights and remedies herein provided are cumulative and may be
exercised singly or concurrently, and are not exclusive of any rights or
remedies provided by law.

        SECTION 11. WAIVERS, AMENDMENTS; APPLICABLE LAW.

               None of the terms or provisions of this Agreement may be waived,
altered, modified or amended except by an instrument in writing, duly executed
by the parties hereto. This Agreement and all obligations of the Pledgor
hereunder shall together with the rights and remedies of the Company hereunder,
inure to the benefit of the Company and its successors and assigns. This
Agreement and the rights and obligations hereunder shall be governed by, and
construed in accordance with, the laws of the State of New York.

        SECTION 12. ENTIRE AGREEMENT.

               This Agreement amends and restates the Existing Pledge Agreement
in its entirety, and this Agreement contains the sole and entire agreement
between the Company and the Pledgor with respect to the subject matter hereof
and thereof and supersedes all prior or contemporaneous arrangements or
understandings with respect hereto or thereto.

                                   * * * * *



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               IN WITNESS WHEREOF, this Amended and Restated Pledge Agreement
has been executed as of the date first above written.


                                            /s/ MICHAEL R. MCBRAYER
                                            ------------------------------------
                                            MICHAEL R. MCBRAYER




                                            DONJOY, L.L.C.


                                            By: /s/ LESLIE H. CROSS
                                               ---------------------------------
                                               Name: Leslie H. Cross
                                               Title: President/CEO