Abstract:
An orthopedic brace designed to immobilize the knee by preventing flexion/extension and limiting medial/lateral movement. The brace includes a main support structure embodied in a unitary, rigid stay member with slidable, semi-rigid cuffs at one or both ends to provide length adjustability. The stay member has no popliteal articulation in order to immobilize the knee joint, and further provides attachment for a Velcro strapping system for easy application to the posterior of the leg. A breathable foam softgood insulates the leg and knee from the main support structure and strapping system yet is completely detachable from the brace so it can be trimmed to any desired length or width, and washed as necessary.

Description:
BACKGROUND OF THE INVENTION 
   The present invention is directed to an orthopedic brace. More precisely, the present invention is directed to a knee immobilizer. 
   The knee is probably the least protected joint in the human body. There is no ball and socket or mortice to hold the ends of the femur and tibia in their place. There are simply a few ligaments to hold everything together. Yet the knee carries the weight of our bodies and thus is subjected to more forces than any other joint in our anatomy. 
   The knee allows free flexion and extension of the lower leg and limited medial and lateral movement (rotation). If enough force is applied to the knee this rotation will increase and damage or tear the supporting ligaments. Damage can also result from the knee being bent backwards (hyperextension). 
   Once damage is done to the ligaments, the injured tissue needs time to heal. In many cases, simple rest is inadequate and surgery may be required to repair the damage. The present invention relates to a knee support that is worn to immobilize the knee after an injury as a form of treatment or as a temporary measure to prevent further injury before other treatments can be applied. 
   Most conventional knee immobilizers or braces on the market today are no different than the ones sold 20 years ago. They are simply pieces of foam with straps and pockets attached by sewing. Usually there are three pockets—one behind the knee (posterior), and one on each side of the knee (medial and lateral). Metal stays are inserted into these pockets to provide support and immobilization to the knee. 
   These conventional designs have several disadvantages. For example, they have a multitude of straps that make the knee brace confusing to use and time consuming to apply. Once the brace is applied to the leg, it tends to “piston” or migrate down the patient&#39;s leg because the medial/lateral stays are straight and do not follow the contours of the leg. Once the brace migrates out of position relative to the knee, the intended function is greatly reduced. Finally, conventional knee braces are not size/color adjustable so that medical practices must stock a multitude of sizes and colors as needed to fit the varying anatomy of their patients. These and other problems associated with conventional knee braces are overcome in accordance with various embodiments of the present invention. 
   SUMMARY OF THE INVENTION 
   The present invention is directed to a knee immobilizer. In one preferred embodiment, the knee immobilizer has an adjustable length for supporting the leg of a patient and comprises an elongated stay member disposed posterior to the leg having a femoral portion, a tibial portion, and a non-articulating popliteal region therebetween; a femoral cuff slidably disposed on the femoral portion; a tibial cuff slidably disposed on the tibial portion; means for selectively setting the linear position of the femoral and tibial cuffs relative to the femoral and tibia portions; and at least one liner that at least partially envelopes the leg, disposed on at least one of the stay member, the femoral cuff, and the tibial cuff. 
   In one embodiment, fewer straps are required because the femoral and tibial cuffs are designed to wrap around and cradle the muscle bellies of the leg. The result is an increase in the level of support with fewer straps and no medial or lateral stays. This increased support and the absence of the medial and lateral stays, allow for a much closer fit to the patient&#39;s anatomy, thereby greatly reducing the pistoning of the brace relative to the leg during use. 
   The stay member has an engineered geometric shape following the contours of the leg that provides all the immobilization necessary and is set at a functional angle of immobilization. Therefore, no articulation or hinge is needed at the popliteal region of the knee joint for ensuring proper fit as can be seen in the prior art braces. No tools are necessary for adjusting and setting that articulation which is now omitted. Omitting the articulation also enhances the strength of the popliteal region under bending and torsion, thereby further protecting the injured knee from unintended motion. There is further no risk of the articulation loosening in use since the articulation is omitted. 
   In addition, the sliding cuff-posterior stay assembly provides length adjustment via a simple push button actuator. Being made preferably from a semi-rigid polymer, the cuffs have opposed flexible arms that at least partially circumscribe the patient&#39;s limb. In a preferred embodiment, these cuffs are attached to more rigid plastic and contains push button adjustment means for adjustment relative to the stay. Both adjustments are easily performed without tools and can be undertaken by the patient if necessary. Accordingly, the knee immobilizer can be custom tailored to fit the patient&#39;s leg regardless of his or her gender, height, girth, musculature, etc. Finally, the foam liner is fully detachable from the cuff-posterior stay assembly. Removal allows trimming of the liner to the appropriate length and width for each patient and, when laminated with two different colored materials, color options for the end user by simply reversing which side is facing out. The removable liner also allows for a different configuration of the brace without any liner at all. This embodiment would have just minimal or no padding over the cuffs and strategic portions of the straps and D-rings. Some advantages to this brace are that it feels cooler to a user when worn in warm climates and environments; it possesses a lower profile which would allow for fitting under the user&#39;s clothing; and it further reduces pistoning. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
       FIG. 1  is a perspective view of a preferred embodiment knee immobilizer. 
       FIG. 2  is a perspective view of one end of a stay member having medial and lateral struts and a hinge away from the popliteal region of the knee joint. 
       FIG. 3(   a ) is a cross-sectional view of the stay member taken at line  3 - 3 . 
       FIGS. 3(   b )- 3 ( i ) are cross-sectional views of various alternative embodiment stay members. 
       FIGS. 4(   a ) and  4 ( b ) are side elevational views of two stay members. 
       FIG. 5  is a rear elevational view of the stay member and cuff assembly without the liner. 
       FIG. 6  is a perspective view of one cuff detached from the stay member. 
       FIG. 7  is a front elevational view of a liner with the panels open. 
       FIG. 8  is a front elevational view of the line of  FIG. 7  with the panels closed and secured by hook and loop fasteners. 
       FIG. 9  is a side elevational view of the knee immobilizer is use on a leg of a patient shown in phantom lines. 
       FIG. 10  is a perspective view of an alternative embodiment knee immobilizer. 
       FIG. 11  is a side elevational view of an alternative embodiment knee immobilizer attached to a leg of a patient. 
       FIG. 12  is a side elevational view of an alternative embodiment knee immobilizer with medial and lateral stay members. 
   

   DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
   The present invention is directed to an orthopedic brace for support of an injured limb. In the preferred embodiment, the present invention is directed to a knee immobilizer. As seen in the perspective view of  FIG. 1 , the knee immobilizer or brace  10  is preferably constructed of a rigid support structure  12  acting as a spine and incorporates an optional foam compressive liner  14  and a strapping system consisting of four straps  16 ,  18 ,  20 ,  22 . As seen in  FIG. 9 , the knee immobilizer or brace  10  is shown in normal use. It is attached to the posterior portion of a patient&#39;s leg  24 . 
   In  FIG. 1 , at the top and bottom ends of the stay member  12  are the femoral and tibial cuffs  28 ,  30 , respectively. The cuffs  28 ,  30  slide along the femoral and tibial portions  34 ,  36  of the stay member  12  for quick adjustment of its overall length. An optional popliteal pad  32  is attached to the stay member  12  to further provide support and protect the very sensitive popliteus area of the knee. The popliteal pad  32  is secured to the stay member  12  at the slightly bent popliteal region  38  in between the femoral portion  34  and the tibial portion  36 , as best seen in  FIG. 4(   a ). 
   The rigid stay member  12  resists bending and gives overall stability to the assembly, while the cuffs  28 ,  30  support and cradle the muscle bellies of the leg  24 . The liner  14  with the straps  16 ,  28 ,  20 ,  22  comfortably and securely hold the entire assembly to the leg  24 . When strapped together on the leg  24  as seen in  FIG. 9 , the components work together to immobilize the knee joint and to further prevent unintended rotation of the upper and/or lower portion of the limb that might further injure the knee. Since the popliteal region  38  has no articulation or hinge, the strength and stability in that region are superior to that of a conventional design, and there is virtually no possibility of the knee joint moving if the patient or user is ambulatory. 
   As seen in the  FIG. 1  embodiment, the rigid support structure is specifically a single-piece, rigid stay member  12  made from a unitary, uninterrupted-length bar of metal or high strength material. As shown in  FIGS. 1 and 2 , the stay member  12  has a series of oval holes  26  spaced apart in a specified increments preferably located at both ends of the stay member  12 . The holes  26  allow the positions of the cuffs  28 ,  30  to be adjusted and set relative to the stay member  12 . This adjustment extends or shortens the overall length of the brace  10  to quickly and easily tailor fitment of the knee immobilizer to the unique anatomies of patients of different sex, height, age, physique, weight, etc. 
   The stay member  12  is shown in a side elevational view of  FIG. 4(   a ). The theoretical femoral portion  34 , tibial portion  36  and popliteal region  38  are identified. A first curvature  35  is defined whereat the femoral portion  34  merges with the popliteal region  38 , and a second curvature  37  is defined whereat the tibial portion  36  merges with the popliteal region  38 . The two horizontal dashed lines are parallel and meant to contrast the preferred profile contour of the stay member  12 , intended to closely follow the posterior contours of a human leg. Essentially, the stay member  12  begins as an extruded bar of aluminum having a straight profile, and is carefully fashioned with compound curves as shown in  FIG. 4(   a ).  FIG. 4(   b ) shows an alternative embodiment stay member  40  with a steeper bend in the popliteal region and less angular peaks and valleys. 
     FIG. 3(   a ) is a cross-sectional view of the stay member  12  taken along line  3 - 3  in  FIG. 2 . In this cross-sectional view, it is clear that the stay member  12  has a bowed shape from edge to edge, and includes optional reinforced areas  42  underneath and reinforcement beads  44 . This cross-sectional shape preferably runs uniformly from one end of the stay member  12  to the other. From empirical studies, the preferred embodiment stay member  12  shown in  FIG. 3(   a ) has a cross-sectional shape that has been engineered to provide the ideal strength-to-weight-to-size ratio. It is preferable to minimize the depth of such a stay member in order to limit its effect and discomfort to the patient. 
     FIGS. 3(   b )- 3 ( i ) illustrate the cross-sectional shapes of alternative embodiment stay members, some having a channel, reinforcement beads, etc. placed at different locations for best strength to weight ratio and optimum bending area moment of inertia. The stay member  12  may be a solid material or may have a hollow core at least for a lengthwise section thereof, as shown in the  FIG. 3(   g ) embodiment. In the preferred embodiment, the stay member  12  is extruded from aluminum, but other high strength metals, laminated polymer composites, woven graphite, or fiber reinforced plastics or the like are contemplated. Furthermore, the polymers and metals can be integrated or laminated for different strength, weight, cost, durability, and other engineering considerations. The stay member may further take the form of bundled rods or multi-layer bars or any combination thereof. The rods or bars may be co-extruded with a polymer cladding in various alternative embodiments. 
   Preferably, the stay member should at least meet a bending load of about 25 ft-lbs. or more for knee immobilizers to be used by adults. Hence, the length, width, thickness, and cross-sectional area moment of inertia of the stay member should be considered to at least support such load bearing requirements. Furthermore, its length should be sufficiently long so that the femoral portion  34  and the tibial portion  36  extend well past the popliteus for comfortable load bearing of the body weight of the patient or user, and to provide sufficient slide adjustment motion for the cuffs  28 ,  30 . In the preferred embodiments, the brace  10  spans from about 18 to 24 inches in overall length. 
   In the embodiment shown in  FIG. 2 , optional lateral and medial struts  46 ,  48 , have been added to the support. These two struts  46 ,  48  are located on one or both sides of the knee, providing additional medial/lateral support and protection to the knee. The lateral and medial struts  46 ,  48  may be welded, bonded, Velcroed, fastened, or likewise mechanically attached to the stay member  12  or the liner  14 . Each strut  46 ,  48  optionally has a slight forward curvature to at least partially circumscribe the knee. The forward curvature gives some protection from accidental external impact and further stabilizes the injured knee. The lateral and medial struts  46 ,  48  may be simple cantilevered bars as shown in  FIG. 2 , or may have a more integrated, complex form similar to the arches  78  shown in  FIG. 10  except that the side hinges  82  are omitted. 
   Also shown in the  FIG. 2  embodiment is an optional articulation or hinge  50  located away from the knee along the posterior of the leg. The hinge  50  allows the stay member  12  to break into two discrete sections along separation line  52  and linked only at the hinge  50 . Once opened to a desired angle for the two sections, the hinge  50  can be locked down using a threaded nut or other means known in the art thus freezing the angle of the bend. The hinge  50  therefore gives greater adjustability to the stay member  12  for improved fitment to the hamstring area (or calf area if the hinge is located there) of the patient&#39;s leg. 
   In  FIG. 2 , the tibial portion  36  and its end are shown. Four holes  26  a are cut, drilled, or otherwise formed into the stay member  12  for setting the location of the tibial cuff  30 , mentioned earlier. In the preferred embodiment, there are four oval shaped holes equally spaced apart at each end of the stay member  12 . Of course, the number, size, shape, and location of the holes can be modified from that shown to suit various design and engineering objectives. In one alternative embodiment (not shown), the stay member may have score marks, notches, grooves, or the like so that its length can be more easily shortened by breaking off a section at the score mark rather than sliding the cuff along the length of the stay. 
     FIG. 5  shows a rear view of the knee immobilizer with the liner  14  removed. Attached to the ends of the stay member  12  are the slightly larger femoral cuff  28  and the slightly smaller tibial cuff  30 .  FIG. 6  shows a single cuff  30  in a perspective view. These cuffs  28 ,  30  in a preferred embodiment are made of a semi-rigid plastic and are designed with strategically placed windows  54  to allow them to flex and shape around the anatomy of the leg. Preferably, the cuffs  28 ,  30  have a generally curved or arcuate shape to at least partially circumscribe the leg. The curvature may be molded into the material, or the cuff may be formed flat and the curvature created by pulling on securing straps. 
   In forming that arcuate shape, each cuff  28 ,  30  has opposed arms  62  with an optional curl. Within the opposed arms  62  are one or more windows  54 . Also, the arms  62  may have a thinner wall thickness than at the common base of the curve. All together, the thinner wall at the arms  62  and the windows  54  where material has been removed provide flexibility and diametrical adjustability of the cuff  28 ,  30  for ideal user comfort and customized fitment to his or her leg. On the other hand, the bulkier base area of the cuff  28 ,  30  ensures stability and positive engagement when the cuff  28 ,  30  is assembled to the adjusters  56 , 58  and stay member  12 . 
   As seen in  FIG. 6 , the cuff  30  may have a patch of hook fastener material  64  for attachment of to the liner  14 . The wall thickness change in the arms  62  may be gradual as shown, where the outer ends are the thinnest, or the change may be stepped. The size, location, and number of windows  54  may be altered from that shown. The preferred shape for the windows  54  is an elongated oval as shown, with the outermost windows  54  in the arms  62  being used for lacing one or more straps  16 ,  22  therethrough, as shown in  FIG. 1 . 
   In  FIGS. 5 and 6 , the cuffs  28 ,  30  are attached to the stay member  12  via a femoral adjuster  56  and a tibial adjuster  58 . In the preferred embodiment, the adjusters  56 ,  58  are attached to each respective cuff  28 ,  30  by three rivets. Other means of attachment are contemplated, such as by bonding the parts together, snap fitting, welding, or forming the cuff and adjuster in a single integral piece. 
   In an alternative embodiment, the discrete adjuster and cuff are joined together by a hinge or pivot  39  as seen in  FIG. 9 . This way, when the knee immobilizer is worn by the user, the cuff has a slight rocking action to more readily adapt to the user&#39;s unique leg shape. Finally, although the preferred embodiment shown in  FIG. 1  depicts only two cuffs, it is of course contemplated that the knee immobilizer may have only one cuff, or more than two cuffs depending on the treatment necessary to the injured knee, the unique anatomy and physical needs of the patient, etc. 
   Once assembled together, the stay member  12  easily slides inside the slots  60  created in each adjuster  56 ,  58 , wherein the slots  60  are of the same shape as the outer surface of the stay member  12 . With this arrangement, the adjusters  56 ,  58  enable each respective cuff  28 ,  30  to freely slide linearly along the ends of the stay member  12 . 
   To achieve length adjustment of the knee immobilizer, the cuffs  28 ,  30  initially slide freely along the ends of the stay member  12 . Once the ideal length adjustment is determined, the sliding action of the cuffs  28 ,  30  should be disabled. To do this, a means for setting the location of the cuffs  28 ,  30  relative to the stay member  12  is needed. In the preferred embodiment shown in  FIGS. 1 and 5 , a button assembly  66  is used, which includes a button and spring. The button assembly  66  is encapsulated between the cuff  28 ,  30  and adjuster  56 ,  58  during the riveting operation, wherein the button is biased by the spring into one of the holes  26  in the stay member  12  when the stay member  12  is located in the adjuster  56 ,  58 . Accordingly, the length of the brace is adjusted by pressing the button down so the cuff assembly can be slid farther up or down the stay member  12 . When the cuff assembly is adjusted so the next oval hole  26  is overlying the biased button, the spring forces the button up into that oval hole, thereby positively locking the location of the cuff  28 ,  30  on the stay member  12 . This process is repeated until the desired size is achieved. 
   Beneficially, no tools or accessories are required for such an adjustment, and each cuff can be adjusted with one hand. The adjustment is simple enough so that it can be performed by a patient or user with no training. 
   Other means for setting the location of the cuffs  28 ,  30  relative to the stay member  12  and modifications thereto are contemplated. For example, the preferred embodiment can be modified to rearrange the relative locations of the button, spring, and holes. In this modification, the holes may be located along the edge of the stay member with a biased pin extending sideways through the adjuster into the selected hole thus locking the two together. Again, a positive mechanical engagement is achieved between the stay member and the cuff via the adjuster. Of course, as suggested above, the adjuster structure can be omitted and a simple slot can be formed integrally into the cuff. 
   In an alternative embodiment, a mechanical rack and pinion system can be used replacing the button assembly and holes, wherein the edges of the stay member have teeth that engage the complementary gear teeth of a rotating pinion, whose rotation can be locked down by a thumb screw to immobilize the overall relative sliding action. The pinion can be replaced by a movable finger attached to the cuff that is spring biased into the teeth at the edge of the stay member. Rocking the finger over a pivot point or similarly withdrawing the finger away from the teeth enables the sliding action between the stay member and cuff. 
   In yet another embodiment, a frictional lock can be used in the form of a pivoted lever that is rotated and wedged into contact with the stay member and the gripping contact surfaces are optionally covered with a high friction rubber or like grippy material. In still yet another alternative embodiment, a deadbolt system can be implemented similar to its operation in a door, wherein the deadbolt slides under spring bias into a receiving hole in the stay member thus positively locking the two together. Likewise, a stop or surface bump can be used in place of a hole. 
   Yet another alternative embodiment contemplates the stay member sliding inside the slot as shown in  FIG. 1 , but the button assembly is replaced with a threaded thumb screw whose shaft extends through one of the holes or a longitudinal slot in the stay member. The tip of the advancing thumb screw can be threaded into a corresponding hole, groove, or stop in the cuff or adjuster. If the holes are replaced with a slot in this embodiment, the stop settings are not limited to four or however many holes are present but would be technically infinitely adjustable. The tip of the threaded shaft may have a rubber cap to improve grip or wedging action, and to minimize damage to the stay member if the user overly torques the thumb screw. All such similar mechanical locking mechanisms are contemplated. 
   In various alternative embodiments, the adjuster can be welded, bonded, or permanently secured or affixed to the stay member at one end thereof eliminating the slide adjustment while the opposite end of the stay member has a cuff that remains slide adjustable. For example, the tibial cuff can be permanently affixed to the stay member and the femoral cuff would slide along the stay for length adjustments and patient comfort. If a pivot  39  as in  FIG. 9  is used between the adjuster and the cuff, there is some rocking action and “play” for the cuff relative to the stay member. Accordingly, a cuff may then be affixed to the stay member without any slide adjustment for rocking action only, or the pivot may add a rocking action in addition to the linear adjustment of the cuff. 
     FIG. 7  shows a preferred embodiment foam compressive liner (i.e., softgood)  14  with four panels  68 . The foam liner  14  is made of a non-rigid porous material with UBL (unbroken loop) material laminated to both sides. The UBL can be the same color or different colors to offer color options for the end user. Along one edge of the foam liner  14  are located removably attached hook fastener (e.g., Velcro hooks) tabs  70 , as best seen in  FIG. 8 , which shows the panels  68  folded over and attached to the tabs  70 . These tabs  70  can be easily removed, relocated, and reapplied after optional trimming of the foam liner  14  for sizing. During application of the knee immobilizer  10  to the user&#39;s leg, the tabs  70  hold the foam liner  14  closed to free up the hands of the end user for securing the straps  16 ,  18 ,  20 ,  22 . 
   Still in  FIG. 7 , the diameter of the liner  14  at the top is greater than at the bottom to accommodate the greater diameter of the limb above the knee than below the knee. A slit or cut line  72  is provided to relieve the pressure over the patella. Additional slits  73  may be provided as guides for further cutting of this slit when the liner is cut down in width for thinner and/or smaller legs. The patella may protrude through the slit if it is left open, or the patella may be covered by liner material. 
   In various alternative embodiments, the liner may include size indicia or markings  100  to assist medical practitioners or the user in altering the liner to fit more properly or comfortably. These markings  100  may be perforations cut into the pattern during the die cut stage, or may be printed thereon to give visual guides to the medical practitioners during the trimming and sizing of the softgood liner. An ethylene foam liner may be added to the cuff for added padding and comfort. A patellar cut  72 , seen in  FIGS. 7 and 8 , may be left open or covered in an elastic material that is sewn into the liner. Also, the popliteal pad  32  may be formed into the layers of or sewn into the liner  14  to minimize shifting of the pad  32  in use. 
   The liner  14  is preferably joined to the stay member  12  and/or one or more cuffs  28 ,  30  via hook fasteners or Velcro patches. The liner  14  can be a single sheet with pre-cut and pre-shaped panels  68  as depicted in  FIG. 7  to nestle against the stay member  12  and one or both cuffs  28 ,  30 . Alternatively, each cuff may have its own discrete sheet of liner material. The liner may be bonded or sewn into the cuff, or be molded into the cuff. In short, the resilience, thickness, number of layers, overall shape, size, panel number and shape, and location of the liner or liners relative to the stay member and cuff can all be customized based on user requirements. 
   As seen in  FIGS. 1 and 9 , the knee immobilizer  10  is secured to the leg  24  via a strapping system consisting preferably of four straps, namely, two cuff straps  16 ,  22  and two stay member straps  18 ,  20 . Two of the straps  16 ,  22  are permanently attached to the cuffs  28 ,  30 , one on each. The remaining two stay straps  18 ,  20  are adjustably attached to the rigid stay member  12 . That is, each stay strap  18 ,  20  has an optional loop  74  through which the stay member  12  passes so that the straps can slide and adjust up and down the stay member  12 . Naturally, the stay straps  18 ,  20  can be temporarily or permanently affixed to the stay member  12  if desired by use of hook and loop fasteners, making a knot in the strap, adhesive bonding or welding, or a screw fastener or the like mechanical attachment. 
   The cuff straps  16 ,  22  are preferably fastened using a hook and loop arrangement and D-rings  76 . It is possible to omit the hook and loop fasteners and simply tie a knot at the D-ring, or more preferably, replace the D-ring with a buckle or a clamp. The buckles may employ a side, top, and/or twist release. The liner  14  is removably attached to the support structure (namely, the stay member  12  and cuffs  28 ,  30 ) via strips of Velcro located on the cuffs  28 ,  30  and the stay straps  18 ,  20 , and can have a hook barrier (not shown) in place during shipping to prevent contact of these hook strips until the knee immobilizer is properly applied to the patient and adjusted. Once the knee immobilizer is fully adjusted and applied, this additional Velcro hook barrier is removed from between the back stay member  12  and the foam liner  14  to allow the Velcro hook on the cuffs  28 ,  30  and stay straps to grab onto the foam liner and further secure the knee immobilizer. 
     FIG. 10  is a perspective view of another alternative embodiment stay member  80 . The stay member  80  includes the same adjustment means for tibial and femoral cuffs  28 ,  30  as described above to accommodate various length legs on a brace having range of motion hinges  82  on both sides of the patient&#39;s knee. These side mounted hinges  82  can be of the designs shown in, for example, U.S. Pat. No. 5,554,104 (Grim); U.S. Pat. No. D496,464 (Iglesias, et al.); and co-pending U.S. patent application Ser. No. 10/675,324, filed Sep. 29, 2003, titled “Adjustable Ergonomic Knee Brace,” by D. Comier et al.; all of whose contents are hereby incorporated by reference. Each hinge  82  is located atop an arch  78  extending from the stay member  80 , wherein each arch  78  stretches toward the patella on either side of the knee to better restrain lateral and medial movement. As with the various disclosed embodiments, the brace may include a liner, or be made and worn without a liner with minimal padding on the cuffs and straps. Such a brace, described below, would tailor fit various length legs and would provide a post operative knee brace that would again resist pistoning due to the added fitment of the cuffs as described above. 
     FIG. 11  is a side elevational view of yet another alternative embodiment knee immobilizer  86  for use in warm or humid climates. In this “cool” embodiment, the liner is altogether omitted and/or only a thin layer of liner material  98  is used to pad and cushion the cuffs  90 ,  92  only. More preferably, the cushioning liner material  98  substantially covers only the areas of the cuffs  90 ,  92  that touch the patient&#39;s leg and does not extend beyond that limited area. The cushioning liner material  98  is further selected to be thinner with less padding as compared to the foam compressive liner  14  shown in  FIG. 1 , for example. 
   To be sure, the foam compressive liner  14  in the exemplary embodiment is chosen for its ability to wrap around and stabilize the leg while applying a small amount of compressive pressure to the leg. As such, the compressive liner has a durometer of about 20-35 (using a 302SL sponge rubber gauge). It is known that the knee, ankle, or injured joint when immobilized has a tendency to swell. To minimize this swelling, it is further known in the art that applying the compressive pressure to the leg is beneficial, and hence the use of the compressive liner  14 . 
   On the other hand, the cushioning liner  98  is preferably not made from the softgood liner or UBL material. Rather, the cushioning liner  98  uses a foam or like material of sufficiently high durometer (e.g., durometer of 45-60 using a 302SL sponge rubber gauge) to keep the skin of the wearer from bottoming out in the padding and impacting the cuff. In various preferred embodiments, the cuff cushioning liner  98  is made from a closed cell polyethylene foam, or spacer fabrics and the like. It may have a thickness of about ⅛ to ¼ inch and anything therebetween when mounted to the cuff, while the compressive liner is typically thicker. Further, the closed cell cushioning liner  98  may have a laminate and/or coating thereon to prevent direct contact between foam and skin to reduce sweating. 
   The “cool” knee immobilizer  86  again includes components such as a rigid stay member  88 , one or more length adjustment cuffs  90 ,  92 , and securing straps  94 ,  96 . In this instance, the straps  94 ,  96  would either be manufactured with a material that does not irritate the skin, or would have some form of padding, coating, or a cushioning liner applied to the skin-facing side. It is optional that the femoral strap  96  have a greater width for a more secure connection to the leg since the compressive liner is omitted. Further, the femoral strap  96  may apply slight compressive pressure on the leg in place of the omitted compressive liner. The wider femoral strap  96  may have a width of about 3-4 inches wide instead of about 2 inches for the other straps  94 . Clearly though, any or all of the other straps  94 ,  96  may have greater widths for the same purposes. 
   Because the compressive liner has been omitted in this  FIG. 11  embodiment, the leg  24  of the patient is mostly open to the ambient air and benefits from the air cooling effect accordingly. Further, without the compressive liner, the knee immobilizer  86  is less bulky, has a lower profile or silhouette, and can more easily fit underneath a patient&#39;s pants, rather than over his or her clothing as with most of the conventional products on the market must be worn. Lastly, because the knee immobilizer  86  without a compressive liner allows for a closer, more conforming fit of the cuffs  90 ,  92  to the muscle belly of patient&#39;s leg, the issue of the cuffs unintended pistoning on the leg is virtually eliminated. 
     FIG. 12  is a side elevational view of the knee immobilizer  10  from  FIG. 9  modified with medial and lateral stay members  84 . These optional medial and lateral stay members  84  are held in place by straps  16 ,  18 ,  20 ,  22  and overlies the liner  14 . More preferably, the medial and lateral stay members  84  are Velcroed, strapped, or otherwise mechanically attached to the liner  14 . The primary stay member  12  at the posterior of the leg  24  is still used as are the sliding cuffs  28 ,  30 . When in use, the medial and lateral stay members  84  are located on either side of the injured knee for added medial and lateral support and protection of the knee. For these purposes, the medial and lateral stay members  84  may be made from aluminum bars, rigid plastic strips, or the like, and have a straight length or include a slight bend to follow the contours of the leg. 
   Although the foregoing exemplary embodiments are described for use on a knee, it is understood that the present invention can be applied to other anatomical joints. From the foregoing detailed description, it should therefore be evident that there are a number of changes, adaptations, and modifications of the present invention that come within the province of those skilled in the art. However, it is intended that all such variations not departing from the spirit of the invention be considered as within the scope thereof except as limited solely by the following claims.