Abstract:
A knee brace, method of use thereof, and modification to an existing knee brace facilitates inducing side loads to a knee joint to align upper and lower leg portions relative to one another, thereby allowing the knee joint to function properly over its full dynamic range of motion. The knee brace, whether as manufactured or modified, acts to apply a lateral shear force to the knee joint through application of opposing lateral forces, with one lateral force being above the knee joint in one direction and the other lateral force being below the knee joint in an opposite direction. The counteracting forces act to shift femoral condyles and tibial condyles of the knee joint back into proper lateral alignment without acting directly on the patella to counteract the effects of the patella femoral syndrome.

Description:
CROSS-REFERENCE TO CO-PENDING APPLICATION 
     This patent application claims priority to U.S. Provisional Patent Application Ser. No. 60/771,062, filed Feb. 7, 2006, which is hereby incorporated herein by reference in its entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Technical Field 
     This invention relates generally to knee braces, and more particularly to knee braces worn externally about a knee joint for supporting and manipulating the knee joint. 
     2. Related Art 
     As is known, and shown in  FIGS. 1 and 2 , a knee joint  10  is the largest joint in the body and has a unique anatomy due to its unusual movement. Though it may appear to the casual observer as a simple joint, in actuality, it is extremely complex. The complexity results from the fact that the knee joint  10  has femoral condyles  12  that rotate downward and slightly medial with each flexion of a lower leg portion, then rotate slightly backward and upward with the extension of a lower leg portion  14  relative to an upper leg portion  15 . Accordingly, the rotation of the knee joint results in a three-dimensional movement, rather than a two-dimensional movement seen in more simple joints, such as an elbow, for example. 
     The knee joint  10  is made up of three bones which interact with one another to provide the three dimensional movement of the joint. One of the bones is the largest bone in the body, the femur  16 , which supports the upper leg portion  15  and is commonly referred to as the thighbone. Two others are the tibia  18 , which is commonly referred to as the shinbone, and the patella  20 , which is commonly referred to as the kneecap. In addition to the femur  16 , the and tibia  18  has ends referred to as condyles, each of which are bifurcated into lateral and medial condyles  22 . The femoral condyles  12  and the tibial condyles  22  are separated from direct frictional engagement with one another by separate layers of cartilage, commonly referred to as the lateral and medial meniscus  24 ,  25 . Each meniscus  24 ,  25  is generally C-shaped, and fits into the joint between the femoral condyles  12  and the tibial condyles  22  to facilitate rotating and sliding movement therebetween. To further facilitate proper movement and reduce friction within the knee joint  10 , a synovium tissue, which produces synovial fluid, lubricates the joint. Of course, the knee joint  10  includes many tendons and ligaments to produce the movement of the knee, and to stabilize its alignment, some of which are discussed hereafter. 
     The femoral condyles  12  are generally quite rounded and are bifurcated to form an inverted V-shape groove  26  traversing anterior and posterior sides of the knee. The respective tibial condyles  22  are generally somewhat less rounded, and produce what is commonly referred to as the tibial plateau. The tibial plateau also has a small V-shaped groove  28  traversing the anterior and posterior sides of the knee in generally mirrored relation to the groove  26  in the femur  16 . The middle portion of the tibial plateau has a slight up cropping on which anterior (ACL) and posterior (PCL) cruciate ligaments attach. The cruciate ligaments stabilize the knee front to back. 
     The medial meniscus  25  (on the inside portion of the knee) and the lateral meniscus  24  (on the outside portion of the knee) are in the shape of cartilage rings which circumvent the edges of the tibial condyles  22  to create a cushion for the tibial plateau. The rings define generally convex receptacles for receipt of the rounded femoral condyles  12  throughout their range of motion. Preferably, the femoral condyles  12  are maintained in a generally snug fit within the receptacles to prevent slop or wobbling of the femoral condyles  12  relative to the tibial receptacles. Accordingly, in a properly functioning knee joint, the femur  16  articulates relative to the tibia  18  in a smooth and stable motion. 
     The patella  20  functions to tension the knee joint  10  throughout its range of motion, as well as to protect the joint from impact forces. The patella  20  is maintained in position to follow a slight deviation medially and laterally while remaining within in the V-shaped grooves  26 ,  28  between the femoral and tibial condyles  12 ,  22 . Proper alignment of the patella  20  during articulation of the knee joint  10  prevents damage to the tibial condyles  22  and the separate meniscus  24 ,  25  as it tracks across them. The patella  20  also tracks with a slight rotation in its upward and downward movements. The patella  20  fits into the inverted V-shaped groove  26  of the femur  16  and tracks over the smaller frontal V-shaped groove  28  of the tibia  18  ( FIG. 5 ). The shape of the patella  20  is roughly that of an inverted pear, which is rounded and smooth on an outer surface  29 , and providing a generally V-shaped projection  30  on an underside to define laterally spaced, generally concave portions  32  which track over the femoral condyles  12 . The precise shape of the patella  20  and the underside projection  30  and curvatures  32  varies from person to person. In some people, the projection  30  is generally pronounced and in others it is more subtle. It is believed that people having a more pronounced and sharp projection  30  on the underside of the patella  20  encounter more problems with tracking of the patella  20  during articulation of the knee joint  10 . 
     The knee joint  10  is designed to withstand generally large forces vertically, typically up to 400 pounds or more, however, it is not designed to withstand significant side forces, whether originating laterally or medially. With normal usage, the knee joint  10  will generally last a lifetime, yet one-quarter million Americans require knee replacement surgery every year. Accordingly, something out of the ordinary generally must happen to the knee joint  10  for it to require medical attention, such as surgical repair or replacement. 
     Unfortunately, the high degree of mobility of the knee joint  10  means it is more susceptible to being shifted off its midline plane  34  either laterally or more commonly, medially. This condition is commonly known as patello-femoral syndrome ( FIGS. 3 ,  4  and  6 ). Once the knee joint  10  is shifted off the mid-plane  34 , an individual&#39;s body weight, in addition to increased vertical compression loads generated in use, generates a side or shear load due to the misalignment. The shear load results in laterally opposite loads that are not desirable for normal operation of the knee joint  10 . This new, skewed force vector will continue to create additional shear forces throughout the knee joint  10  with each and every flexion, thus, further skewing the shear force vector angle from its normal vertical direction. Eventually, the shear forces cause accelerated wear to the aforementioned components of the knee joint  10 , and create a degree of slack in the affected medial and lateral tendons such that they are no longer able to maintain the femur  16  and tibia  18  in their proper stable alignment relative to the midplane  34 . As a result, the patella  20  is no longer able to track in the V-shaped grooves  26 ,  28  between the femoral and tibial condyles  12 ,  22  during flexion of the knee joint  10 , thereby leading to collateral damage. 
     When the femur  16  and tibia  18  are not correctly aligned, or if the meniscus  24 ,  25  is damaged, the femoral condyles  12  do not fit properly into the cavities of the meniscus  24 ,  25 . In turn, this can cause the patella  20  to continually track improperly directly over the meniscus  24 ,  25  instead of through the V-shaped groove  28  of the tibial plateau. A relatively minor lateral shift of the patella  20  can decrease the surface contact area by 60%, and consequently increase the shear forces by 2½ times, depending on the sharpness or degree of the protrusion  30  on the underside of the patella  20  and the angle at which the protrusion  30  comes down on the meniscus  24 ,  25 . 
     If the misalignment of the patella  20  is bad enough, the meniscus  24 ,  25  can be cut by the protrusion  30  to create a flap, wherein the flap can interfere with the flexion of the knee joint  10 , and in some cases, get pinched during flexion, thereby causing extreme pain. Eventually, continued wear can result in shredding of the meniscus  24 ,  25 , which can result in the meniscus  24 ,  25  being unable to contain the femoral condyles  12 . Accordingly, once off track, the patella  20  can further irritate or injure the cartilage covering the condyles  12 ,  22 , in addition to tearing or shredding the meniscus  24 ,  25 . Any irritation or injury will initiate a typical body response of inflammation, pain and swelling. If this condition persists, the body may then mount an anti-inflammatory response to destroy or cordon off the inflamed tissue, thereby forming chondromalacia under the knee cap  20 , more swelling and more fluid. This begins a vicious cycle in which the knee cartilage can be destroyed, and if left unchecked, the bones can be damaged. 
     Surgical intervention may be necessary to remove the flap of meniscus  24 ,  25  or to smooth out the shredded meniscus surface and to scrape off chondromalacia from the underside of the patella  20 . Accordingly, the procedure generally reduces the size of the meniscus wall, thereby reducing the ability of the menisci  24 ,  25  to contain the femoral condyles  12  throughout a full range of motion of the knee joint  10 . In addition, scraping the underside of the patella  20  can result in further irritation, and thus, can eventually result in more chondromalacia being formed. As a result, eventually, the knee joint  10  may need to be replaced. 
     The above-described condition of patello-femoral syndrome is commonly diagnosed by elimination. This is because the condition requires only a very small degree of misalignment of the femoral and tibial condyles  12 ,  22 , the menisci  24 ,  25  and the tendons of the adjacent muscles. These changes are not normally detectable by MRI, CT scan, X-Ray or other non-invasive means. Yet, even a small correction of the misalignment back toward the proper alignment of the Q-angle, defined as the angle between the patellar tendon and the quadriceps, has an unexpectedly great decrease on the effects of the patello-femoral condition, and thus, a great decrease in the pain caused by misalignment. 
     Patello-femoral syndrome can be identified by knee arthroscopy, which is an invasive procedure. Arthroscopy can show chondromalacia of the patella  20 , fluid in the knee capsule, cyst in the knee joint  10 , and if great enough, both fluid and cysts may also be shown by MRI. Further, shredding and/or tearing of the menisci  24 ,  25  covering the tibial condyles  22  cannot be seen. 
     In an attempt to correct the small degree of misalignment in a knee joint  10 , traditional knee braces are often used under a misconception that they are effective in correcting a patello-femoral condition. However, traditional knee braces are generally not effective in correcting the misalignment condition, or in lessening the pain associated therewith, since they typically apply equal and circumferentially uniform pressure on and around the knee joint  10  and the adjacent portions of both the lower and upper leg portions  14 ,  15 . Some traditional braces have hinges to limit flexion of the knee joint  10  in bending and raising the lower leg portion  14 , and also help to prevent side-to-side motion of the knee joint  10 . Other knee braces have rigid side bars to further limit the range of motion of the knee joint  10  from side-to-side. Although these knee braces can be effective in restricting movement of the knee joint  10 , they are largely ineffective in correcting a patello-femoral condition due to their application of equal and circumferentially uniform forces about the knee joint  10 , and to their inability to realign misaligned femoral and tibial condyles. 
     Most of the less expensive knee braces are sleeve-type, which are generally both difficult to put on and uncomfortable after continued use. In addition, sleeve-type braces made of neoprene inhibit heat dissipation and restrict the flow of blood to and from the knee joint  10 , and thus, often result in swelling and pain. Some of the sleeve-type braces include hinges to support the knee joint  10  along the medial and lateral sides, but they limit the natural side-to-side rotation of the femur  16  during flexion. This limited side-to-side movement can prevent the knee joint  10  from making a complete recovery from damage, thereby preventing it from returning to its normal range of motion. This can result in further complications by allowing the muscles to be trained to move the knee joint  10  in an unnatural motion. In addition, rigid side bar braces also prevent normal rotation of the femur  16  present in its normal 3-D path of movement, and thus, do not allow natural tracking of the knee joint  10 . Accordingly, they can also be ineffective in correcting a patello-femoral syndrome condition. 
     To overcome the difficulties of putting on sleeve-type braces, wrap-around knee braces are commonly used. The wrap around knee braces presently available also apply equal and circumferentially uniform pressures on and around the knee joint  10 , and thus, are equally ineffective in treating a patello-femoral syndrome condition. In known wrap-type knee braces, straps above and below the knee joint  10  extend from the same side of the knee brace and are wrapped around the leg in the same circumferential direction. This contributes to the effect of placing equally directed pull forces above and below the knee joint  10 . Wrap-around knee braces that have a main body portion of the brace behind or posterior to the knee joint  10  primarily support the upper and lower portion of the tendons attached to the patella  20 . As such, these function to stabilize the pulley action of the patella  20 , and may allow some rotation of the femur  16 , but also result in an unnatural motion of the patella  20  by restricting its range of movement. In addition, they do not affect the realignment of the femoral or the tibial condyles  12 ,  22 . As mentioned, if the femoral and the tibial condyles  12 ,  22  are misaligned, even slightly, the patella  20  cannot track correctly, and it will eventually damage the cartilage, menisci and synovial tissue that covers the adjacent surfaces of the bones which move over each other during flexion of the knee joint  10 . 
     Another known wrap around knee brace construction is shown in U.S. Pat. No. 5,873,848, in which three separate straps are used to impart a side force directly on the patella to realign the knee joint. One strap is first fastened above the knee joint, then another is fastened below the knee joint, while a third strap is fastened to the first and second straps, with the third strap engaging the patella to cause its realignment. Not only is this a complicated mechanism to apply, but it also attempts to correct a patello-femoral syndrome condition by applying a side force directly on the patella. Though this may provide temporary relief to symptoms associated with the patello-femoral syndrome condition, it is not believed to be the best way to correct the source of the problem associated with the condition, which is misalignment of the femoral condyles relative to the meniscus and tibial condyles, and not misalignment of the patella. 
     A knee brace constructed in accordance with the present invention overcomes or greatly minimizes any limitations of the knee braces described above, thereby allowing a knee-joint experiencing a patello-femoral syndrome condition to be properly realigned via a knee brace that is easily applied, wherein the knee brace does not directly act on the patella. As such, a knee brace in accordance with the invention prevents or reduces collateral damage to the knee joint, and possibly negates the necessity for invasive surgical procedures to correct the damaged knee joint, while also providing a most effective recovery of the damaged knee joint. 
     SUMMARY OF THE INVENTION 
     A knee brace constructed according to one aspect of the invention is designed to be mounted on the leg of a user to induce a side-load to correct a patello-femoral syndrome condition in a knee joint by constantly urging femur and tibia bones of the knee joint into proper alignment with one another. The side-load is applied such that it does not act on a patella of the knee joint, and thus, the petalla is able to seek its natural and proper location for tracking during flexion of the knee joint. Accordingly, the knee brace is effective in applying an oppositely directed lateral load above the knee joint, while simultaneously applying a medial load below the knee joint, or vise versa, as necessary to correct the patello-femoral syndrome condition. 
     According to a particular aspect of the invention, the knee brace has a main body portion with opposite sides extending between an upper portion and a lower portion. A first upper strap extends from one of the sides of the upper portion and has a free end for operable communication with the other side of the upper portion to establish one of the side loads. A first lower strap extends from the other of the sides of the lower portion opposite the first upper strap and has a free end for operable communication with the one side of the lower portion to establish the other of the side loads. As such, the knee brace effectively places the knee joint under a constant shear or side load, with one of the femur or tibia being biased laterally outwardly and the other of the femur or tibia being biased medially inwardly, relative to the unbraced condition of the knee joint. In a further aspect of the invention, the amount and intensity of the bracing, and thus, applied loads, can be readily adjusted to best accommodate the present condition of the knee joint in order to correct the patello-femoral syndrome condition to bring the knee joint into proper alignment. 
     Another aspect of the invention includes a method of correcting a patello-femoral syndrome in a knee joint of a leg by realigning femoral condyles of a femur in an upper leg portion above the knee joint with tibial condyles of a tibia in a lower leg portion below the knee joint through the application of a knee brace. The method includes the steps of: applying a side force in one direction on the upper leg portion with the knee brace by attaching the knee brace on an upper portion of the leg, and at the same time, applying another side force in a direction opposite the one direction on the lower leg portion by attaching the knee brace on the leg below the knee joint. Upon disposing the knee brace on the leg, the brace applies a continual counteracting side load to the knee joint to return the femur and tibia in proper alignment with one another, thereby allowing proper tracking of the patella. In one embodiment, disposing the knee brace on the leg includes fastening one side load applying strap above the knee joint without imparting a force directly on the patella to produce a side load in one of the lateral or medial directions, and fastening another side load applying strap below the knee joint without imparting a force directly on the patella to produce a side load in a direction opposite the strap above the knee joint. Further steps may include adjusting the knee brace to apply as much or as little counteracting side loading as necessary by adjusting the tension of the straps. As such, over time, as the knee joint begins to recover, the upper and lower load applying straps of the knee brace can be loosened, as less and less side load will be required to realign the femur relative to the tibia. As such, the knee brace has the advantage of relieving the pain normally associated with patello-femoral syndrome without undergoing an expensive and invasive procedure, with the ultimate goal being to eliminate the need for the knee brace once the muscles and tendons are strong enough to support the knee joint in proper alignment to enable proper tracking of the patella. 
     Yet another aspect of the invention includes a method of modifying an existing knee brace to correct a knee joint having misaligned femoral and tibial condyles. The unmodified knee brace has an upper portion for disposal on an upper leg portion above a knee joint and a lower portion for disposal on a lower leg portion below the knee joint. The method of modifying the knee brace includes the steps of: attaching a generally rigid member to one side of one of said upper or lower portions of the knee brace and leaving a side opposite the one side of the upper or lower portion free from modification. The rigid member acts to induce a side load spaced from the patella on the respective upper or lower leg portion, thereby bringing it into proper alignment with the other leg portion. As such, the knee joint, and particularly the patella, is able to track properly during flexion of the knee joint. Of course, as mentioned above, the ultimate goal is to eliminate the need for the knee brace once the muscles and tendons are strong enough to support the knee joint in proper alignment to enable proper tracking of the patella. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features and advantages of this invention will become more readily apparent to those skilled in the art upon review of the detailed description of presently preferred embodiments and best mode, appended claims and accompanying drawings, in which: 
         FIG. 1  is a schematic front view of a human knee joint with the tibia and femur shown properly aligned; 
         FIG. 2  is an exploded partial plan view of the knee joint looking down on the tibia and illustrated in the proper alignment position of the femur for a normal joint condition; 
         FIGS. 3 and 4  correspond to  FIGS. 1 and 2 , respectively, however, show the knee joint with patella femoral syndrome resulting from misalignment of the femur and tibia across the knee joint; 
         FIGS. 5 and 6  are schematic of the knee joint illustrating the respective proper and improper tracking of the patella relative to the tibia plateau for a normal knee and one afflicted with patello-femoral syndrome; 
         FIG. 7  schematically illustrates correction of the patello-femoral condition through application of a knee brace constructed in accordance with one presently preferred embodiment of the invention to the misaligned knee joint which imparts a corrective shear force to counteract and realign the patello-femoral knee joint to a normal condition; 
         FIG. 8  is a back plan view of a knee brace constructed according to a first embodiment of the invention; 
         FIG. 9A  is a top plan view of the knee brace of  FIG. 8 ; 
         FIGS. 9B and 9C  are plan and cross-sectional views respectively, of a stay incorporated in one embodiment of the knee brace; 
         FIGS. 10 and 11  illustrate the knee brace of  FIGS. 8 and 9  attached to the leg of a person as viewed from the lateral and medial sides, respectively; 
         FIG. 12  is a view of the brace of  FIGS. 8 and 9  shown attached to the leg from the back side of the leg; 
         FIGS. 13 and 14  are respective back and front plan views of a knee brace according to a second embodiment of the invention; 
         FIG. 15  is a view of the knee brace of  FIGS. 13 and 14  shown mounted on the leg of a person viewed from the back of the knee; 
         FIG. 16  is a view like  FIG. 15  but of the front of the knee brace and leg; 
         FIGS. 17-19  illustrate knee braces modified according to the invention; 
         FIG. 20  illustrates a knee brace according to another embodiment of the invention; 
         FIG. 21  is a front view of the brace of  FIG. 20  shown in position on a user&#39;s leg; and 
         FIGS. 22A-B  illustrates a removable pocket that may be releaseably attached to various knee braces to enable the knee braces to impart a shear force across the knee joint with one force being applied above the knee in one lateral direction and the other force being applied below the knee in a medial direction, or vise versa, without applying a force directly on the patella, to correct misalignment between the upper and lower leg portions in accordance with the invention. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Referring in more detail to the drawings,  FIGS. 8-12  show a four-way knee brace  40  constructed according to one embodiment of the invention for imparting corrective shear or side loads resulting in corresponding side pressures above and below the knee joint  10  of a user. The knee brace  40  is adjustable to apply the appropriate magnitude of side forces in the respective lateral and medial directions above and below the knee joint  10  simultaneously to correct a condition of patello-femoral syndrome. The side forces applied opposite one another above and below the knee joint  10  realign the misaligned femoral and tibial condyles  12 ,  22  relative to one another, and in proper alignment with the meniscus  24  ( FIG. 7 ) therebetween. Accordingly, the knee brace  40  relieves any discomfort typically associated with the patello-femoral condition, while also preventing potential or additional damage to the knee joint  10 . As such, the knee brace  40  provides a noninvasive, economical mechanism to remedy a condition of patello-femoral syndrome, with the end goal being to eliminate the need for the knee brace  40  once the muscles and tendons are strong enough to support the knee joint  10  in its proper alignment. 
     As stated above, the four-way knee brace  10  is designed to treat patello-femoral syndrome by applying opposing forces resulting in pressures P ( FIGS. 7 and 12 ) to the lower and upper leg portions  14 ,  15  in a manner so that the upper leg portion  15  is biased or directed in one direction, while the lower leg portion  14  is biased or directed in an opposite direction. Since only a small force is typically required to move the femoral and tibial condyles  12 ,  22  out of relative alignment, it stands to reason that a small force and resulting pressure P is required to bias or push/pull them back into proper relative alignment. Both the femoral and tibial condyles  12 ,  22  must realign for the patella  20  to track correctly in the respective V-shaped grooves  26 ,  28  between them. Application of the knee brace  40  to the injured knee joint  10  corrects the shear pressures off midplane  34  and the misalignment of the femoral and tibial condyles  12 ,  22 , and thus, the pain associated with the condition is either reduced or totally eliminated with extension and flexion of the lower leg portion  14 . Once the misalignment is corrected, continued wearing of the brace  40  will maintain the femur  16  and tibia  18  in proper alignment and help to strengthen and retrain the associated leg muscles to fire in correct alignment. Therefore, the muscles will no longer pull the patella  20 , femur  16  and tibia  18  off track. Accordingly, it is believed that the knee brace applies a torque to the underlying musculature, which results in the muscles being repositioned in their proper orientation and trained to flex the upper and lower leg portions in proper alignment with one another. It should be recognized that all the embodiments of knee braces  40  discussed hereafter, constructed in accordance with the invention, apply generally equal and opposite pressures above and below the knee joint  10  to more correctly align the lower and upper leg portions  14 ,  15  to allow the patella  20  to glide superior and posterior, to rotate and to tilt sideways with the femoral and tibial condyles  12 ,  22 , and to track correctly through the full, normal range of motion of the knee joint  10 . 
     The knee brace  40  has a main body portion  42  with a first upper strap  44  and a first lower strap  46  extending from opposite sides  48 ,  50  of the body  42  in opposing directions to one another. The upper strap  44  extends from an upper portion of the main body portion  42  and from the side  48  and the lower strap  46  extends from a lower portion of the main body portion  42  and from the opposite side  50 . The straps  44 ,  46  are preferably formed as one piece with the main body portion  42  and terminate at free ends  52 ,  54  adapted for operable communication with the main body portion  42 . The straps  44 ,  46  are flexible such that the free ends  52 ,  54  can be wrapped for direct attachment to the respective upper and lower portions of the main body portion  42 . Preferably, the free ends  52 ,  54  are equipped with one of a hook portion or loop portion of a hook and loop type closure  56 , e.g., VELCRO®, while the main body portion  42  is equipped with the other hook or loop portion, thereby facilitating quick and easy attachment and adjustment of the free ends  52 ,  54  relative to the main body portion  42 . However, it should be recognized that any suitable means for fastening the free ends  52 ,  54  to the main body portion  42  could be used, such as snaps, clasps or ties, for example. 
     The main body portion  42  of the brace  40  is intended to be positioned behind the leg, generally opposite the patella  20 , wherein the upper strap  44  of the brace  40  is wrapped around the front of the upper leg portion  15  and above the patella  20 , such that it is spaced from the patella, for attachment of the free end  52  back on the main body portion  42  generally behind the leg. The lower strap  46  of the brace  40  is wrapped in an opposite circumferential direction than the upper strap  44  around the front of the lower leg portion  14  and below the patella  20 , such that it is spaced from the patella, for attachment of the free end  54  back on the main body portion  42 . 
     The knee brace  40  can be equipped with generally rigid members, referred to hereafter as stays  58 , positioned along the side of the femur  16  on one side of the leg and the side of the tibia  16  on an opposite side of the leg. The stays  58  can be attached to the brace  40  in any suitable fashion, however, to facilitate locating the stays  58  on the brace  40 , pockets  60  can be formed at least partially on the straps  44 ,  46 , and preferably on an inner side of the straps  44 ,  46 , for receipt of the stays  58 . To facilitate adjustment of the stays  58 , the pockets  60  are preferably longer than the stays  58 , such as by a predetermined dimension “X”, which could be as much as 1-2 inches or more, as necessary to provide space to allow for minor positional adjustments of the stays  58  within the pockets  60 . As such, the stays  58  can be positioned within the pockets  60  to adjust the direction of the applied force for maximum benefit and comfort. As shown in  FIGS. 22A and 22B , the pockets  60  can be attached as separate features via a hook and loop fastening arrangement, or otherwise, wherein hooks  98  are shown on the pockets  60  for direct attachment to loop features on the fabric of the brace. 
     The stays  58 , and thus the pockets  60 , can be positioned partly on the main body portion  42  of the brace  40  and partly on the respective strap  44 ,  46  to apply opposing pressures to both the respective upper and lower leg portions  15 ,  14 . As such, the upper stay  58  can apply pressure from the medial side of the knee joint  10  toward the lateral side of the knee joint  10  above the knee, and the lower stay  58  can apply an opposing pressure from the lateral side of the knee joint  10  toward the medial side of the knee joint  10  below the knee, thereby realigning the knee joint  10  and leaving the femoral and tibial condyles  12 ,  22  free to track correctly through a complete range of motion of the knee joint  10 . It should be recognized that the knee brace  40  can be provided to apply forces in directions opposite to those described above. In addition, if better for correction of the injured knee, only one stay  58  can be used, usually laterally on the lower leg portion  14 , to push it medially, although, the arrangement of the single stay  58  could be reversed. Accordingly, the stay  58  can be inserted or removed as necessary to obtain the best feel throughout healing and movement of the leg. Further, the stays  58  can be provided in various degrees of rigidity, from being very stiff, to being more pliable, thereby providing additional options throughout the healing process. 
     Once the main body portion  42  of the brace  40  is correctly positioned behind the knee, the straps  44 ,  46  can be adjusted as necessary to reduce or eliminate the patello-femoral condition. Further, the straps  44 ,  46  can be adjusted throughout the day as necessary. It should be recognized the brace  40  is applicable for both the left and right knee. 
     A knee brace  40  constructed according to another embodiment of the invention is shown in  FIGS. 13-16 . The knee brace  40  is similar to the embodiment shown in  FIGS. 8-12 , except for the provision of two additional shorter second upper and lower straps  62 ,  64  extending from opposite sides of the main body portion  42  from the respective longer upper and lower straps  44 ,  46  from the previous embodiment. The second upper and lower straps  62 ,  64  are free from any rigid members, and thus, remain flexible along their length to facilitate attachment to the respective first upper and lower straps  42 ,  46 . Accordingly, the second upper and lower straps  62 ,  64  do not induce countering/canceling forces to the opposite forces induced by the longer first upper and lower straps  42 ,  46 . Otherwise, the knee brace  40  is constructed the same and functions the same. 
     As shown in  FIGS. 17-19 , in accordance with another aspect of the invention, modification of a knee brace  440  having VELCRO® straps  86 ,  88  that wrap around the front upper and lower leg portions  15 ,  14 , with a main body portion  442  of the brace wrapped around the back, without imparting direct forces on the patella, can correct a knee joint with patello-femoral syndrome. A stay  458  can be affixed partially on the main body portion  442 , preferably in a pocket  460  similar or the same as those described above. The stay  458  is partially located on the straps  86 ,  88 , one above the knee and one below the knee, spaced from the patella, on opposite sides of the respective upper and lower leg portions  15 ,  14 . If the brace  440  is constructed from two layers of material, such as neoprene, sewn together at the edges ( FIG. 27 ), a pair of horizontal stitch lines  90  can be sewn laterally across the brace  440  from the points of attachment of the straps  86 ,  88 , top and bottom, to form upper and lower enclosed pockets or channels  92 ,  94 , respectively, for receipt of the stays. A small slit  96  is then made through the back of the brace  440  for insertion of the stay  458  into the desired location of the enclosed channel. 
     The embodiment shown in  FIGS. 20 and 21  is a wrap-type brace  640  similar to that shown in  FIGS. 13 and 14 , but lacking the stays  58  and stay pockets  60 . The brace  640  includes a body  642  and straps  644 ,  662  and  646 ,  664  which extend from the body  642  to give the brace  640  an overall H-shape, but with the straps  644  and  646  being relatively longer than their opposing counterpart straps  662  and  664 . It will be seen that the longer straps  644 ,  646  include a hook-type closure piece  656  which, when the brace  640  is wrapped about the leg as shown in  FIG. 21 , latches onto and is secured to the fabric of the respective shorter straps  662 ,  664 . In addition, the upper strap  644  may be longer than the lower strap  646  to account for the larger diameter of the upper leg portion  15  relative to the lower leg portion  14 . 
     Looking in particular at  FIG. 21 , it will be seen that the body  642  of the brace  640  is applied to the back of the knee and the straps  644 ,  662 ,  646 ,  664  are wrapped about the front of the leg. As viewed from the top of the leg looking down, the strap  644  is wrapped counter-clockwise about the upper leg portion  15  and attached to the corresponding shorter strap  662 , whereas the lower strap  646  is wrapped clockwise and attached to the corresponding shorter strap  664 . It is believed that this counter-wrapping of the straps  646  and  644  has the effect of exerting a torque on the underlying musculature, thus, resulting in laterally opposing forces F 1 , F 2  on the leg above and below the knee joint  10 , respectively. The forces F 1 , F 2  are applied away from the patella  20 , and thus, the patella  20  remains substantially free from any directly applied forces as a result of the knee brace  640 . This results in counter-acting shear forces which has the effect of moving the upper leg  15  inwardly and the lower leg  14  outwardly to bring the upper and lower leg portions  15 ,  14  into proper axial alignment with one another to facilitate proper tracking of the patella  20  without acting directly on the patella  20 . Since the patella  20  is not being acted on directly by the knee brace  640 , the patella  20  is able to seek its natural motion within the aligned grooves  26 ,  28  of the femoral and tibial condyles  12 ,  22  without any undue influence from the knee brace  640 . This results in proper functioning of the knee joint, without jeopardy of causing further damage to the joint. Thus, the counter-active shear forces have the effect of correcting the misalignment of the patello-femoral syndrome. 
     The amount of force F 1 , F 2  applied by the straps  646 ,  644  can be adjusted by exerting more or less torque via the circumferential wrap force on the straps  646 ,  644 . In comparison to the brace  40  of  FIGS. 13 and 14 , the magnitude of the resulting shear forces that can be generated will be less since the inclusion of the stays  24  has the effect of applying an increased load than that of the strap material, which enhances the force-applying capabilities of the brace when installed on the user&#39;s leg. In some cases, however, it is contemplated that users with only minor conditions of patello-femoral syndrome may only require a slight correction from the brace, and thus, the brace  640  of  FIGS. 20 and 21  may be sufficient for such users. In addition, those that are using the brace  40  of  FIGS. 13 and 14  may, over time, strengthen the muscles that support the knee such that the requirement or the inclusions of the stays  58  might diminish. As such, at some point the user can remove the stays  58  from their pockets  60  and use the brace  40  in similar fashion as that shown in  FIGS. 20 and 21  to provide some support with shear force action, but less than that of the brace  40  fitted with the stays  58 . 
     It is believed that the counter-wrapping of the straps  644 ,  646  (i.e., wrapping them in opposite directions about the leg above and below the knee joint) is one factor that induces counteracting torques which result in the lateral shear forces across the knee joint  10 , wherein introduction of the stays  658  is another factor that, in the case of a wrap, adds to the counter-wrapping forces applied via the straps  644 ,  646 . 
     The foregoing invention has been described in accordance with presently preferred embodiments, thus the description is exemplary rather than limiting in nature. Variations and modifications to the disclosed embodiment may become apparent to those skilled in the art, and thus, are within the scope of the invention. Accordingly, the scope of legal protection afforded this invention is defined by the following claims.