Patent Publication Number: US-10758393-B2

Title: Orthopedic device

Description:
FIELD OF ART 
     The embodiments of this disclosure are directed to an orthopedic device arranged for intimately fitting to, immobilizing, restricting, supporting, and guiding anatomical segments or joints. 
     BACKGROUND 
     Orthopedic braces and supports are arranged to restrict, inhibit, immobilize, or otherwise control motion about anatomical segments or joints of the human body. These braces and supports provide compression, support, and stability. Many known braces and supports incorporate rigid members and hinges for immobilizing a joint or facilitating movement of the joint. Orthopedic bracing has tended toward greater rigidity to provide ultimate immobilization with a reduced margin of error in mobility, thus many device designs are over-engineered. 
     There tends to be an inverse relationship between the rigidity of the device and patient comfort/compliance. The more rigid the device is, the less likely it will be worn, especially over extended periods of time. If the patient removes a required device to increase comfort, rehabilitation may be hampered and risk of further injury may be elevated. 
     Flexible braces and supports exist which offer compression, support, and stability. However, many are formed from synthetic materials such as Neoprene. These types of braces can give rise to allergic reactions and get hot. Because they typically rely on a sheet of homogeneous material, they lack areas having different properties, and may be ill-fitting or ineffective as a joint requires different areas of compression. 
     Orthopedic devices, such as flexible orthopedic devices and sleeves, provide anatomical fit by conforming to a user&#39;s anatomy for physiologically correct support. They are flexible and arranged for contouring to a body or joint to minimize movement restriction and discomfort. The devices may be configured to stretch in different ways to enable greater muscle stability. In view of their sizing and fit, these devices not only provide support but also improve circulation, and reduce pain and inflammation. Other types of flexible orthopedic devices and/or sleeves may include neoprene and/or other textiles and materials, and may include other tubular configurations or other shapes and configurations as well. 
     Unfortunately, known orthopedic devices are often lacking in adequate strapping and instead rely on their elasticity for being maintained on a limb and/or preventing unwanted migration of the device. These devices are limited to uniform elasticity, whereas the user may require different degrees of elasticity depending on where the device is intended be placed over the anatomy, for different types of recoveries from different types of pathologies, and/or for being retained on the user and treatment of specific anatomy. Such devices may not provide sufficient support, and rather offer more proprioceptive than functional capabilities. 
     In view of the tubular nature of many orthopedic devices including flexible orthopedic devices or sleeves, an issue often arises in migration control. Taking for instance a knee support, as the leg is conical, it is difficult to control the migration of the knee support during repeated movement between flexion and extension. Often straps are used to hold the support on the leg, or light frictional material is applied on the interior of the support. The straps may exert too much compressive force on the leg, creating discomfort and impeding activities of the user. 
     The frictional material which serves to hold the orthopedic device in place must have low frictional qualities so as to allow the user to slide the support on the leg, which has the undesired effect of reducing effectiveness of anti-migration means. Compensating for the use of low friction materials with a more highly compressive body panel in order to better hold the device in place also creates problems, as highly compressive body panels are extremely difficult to don, and when donned are uncomfortable for a user and are thus not suitable for extended use. These current means for migration control require improvement to balance and optimize migration control, ease of use, and donning and doffing of the support. 
     Strap designs in existing devices mistake the proper placement of straps and thus do not offer optimal support for patients suffering from pathologies such as osteoarthritis. Many orthopedic devices feature straps that are connected to each other at a crossing or intersecting point on the orthopedic device, usually directly at and over the hinge located on a medial or lateral side of the device. However, this is not an ideal placement of the intersection of the straps, as it does not effectively unload the knee, and thus does not effectively treat the underlying condition, such as osteoarthritis. Straps may also be difficult to repeatedly apply and adjust. Straps may stray from their intended location on the brace, reducing their effectiveness; straps may also get tangled with each other or be damaged by external forces. 
     Another issue that arises in orthopedic devices is difficulty in donning and doffing due to poor grip on the device by a user. Gripping the tubular body directly can lead to undesired stretching and damage to the device, while also being difficult for a user. Certain orthopedic devices allow for a tab that guides a strap on an outside surface of the device to serve additionally as a “pull tab,” but this needs improvement as it can lead to damage of the tab that must also guide a strap, and may also be inconvenient due to its location, as the tab could catch on objects, further causing damage and inconvenience and making long term use difficult. 
     Orthopedic devices often comprise a patella support for maintaining the patella in position to prevent dislocation. However, patella supports are frequently ineffective at holding the patella in position as the patella supports themselves, which often take the form of a pad attachable within a tubular body, are prone to migration or translation along a user&#39;s skin. Patella supports also can create pressure points or be inflexible which further adds to user discomfort. 
     From the foregoing, there is a need for an orthopedic device that provides improved migration control, comfort, and functionality, while being easier to don/doff, and providing enhanced biomechanical support of a joint, such as by properly locating straps and providing effective patella support. 
     SUMMARY 
     An orthopedic device according to the disclosure arranged for intimately fitting the limb and joint of the user solves the problem of rigid braces and supports deterring a user from proper use and not facilitating joint motion activities. The orthopedic device also solves the problem of orthopedic devices, including flexible orthopedic devices and sleeves, having ineffective migration control and being difficult to don/doff. The orthopedic device also solves the problem of straps intersecting at a location that is ineffective for treating pathologies such as osteoarthritis, particularly of the knee. The orthopedic device also solves the problem of straps being cumbersome to use due to straying from intended locations, tangling, or being damaged by external forces. The orthopedic device also solves the problem of patella supports being ineffective due to undesired translation along skin, being inflexible, or not offering support. 
     The orthopedic device may have restrictive cables, straps, and/or restrictive bands or regions integrated and/or attachable into the construction of the device to restrict and guide the joint. These restrictive cables, straps and/or restrictive bands may be formed from metallic yarns, fusible, textiles, thermoplastic fibers, elastics, or other suitable materials and elements. They may be knit or inlayed during construction of the fabric brace, or mounted externally of the brace; alternatively, they may be modular and attachable to the device or components thereof for each adaptation in initial installation and use. In an embodiment, the orthopedic device comprises straps that intersect at a location that is effective for treating pathologies such as osteoarthritis. The orthopedic device may further comprise tabs for assistance in donning/doffing the device. 
     The embodiments of the orthopedic device define a compliant yet comfortable garment, such as a sleeve or other article, arranged to biomechanically provide motion restriction/facilitation of a joint or body segment. The embodiments are preferably adjustable in functional capacity to match the biomechanical requirements of a user&#39;s treatment plan throughout rehabilitation. The orthopedic device includes various comfort factors to facilitate maximal compliance of the user over the duration of their treatment such as profile, breathability, compression, flexibility, and rigidity. 
     In certain embodiments, the orthopedic device comprises a patella pad with enhanced anti-translation properties that offers support to a patella region and overcomes the problems of existing patella supports by offering enhanced flexibility, pressure relief, and support areas. 
     Embodiments are provided to offer improved migration control over known devices. Embodiments may include means for removing or mitigating migration control during donning and doffing, while offering improved migration control during use. 
     In an exemplary embodiment, the migration control comprises a frictional material placed about the orthopedic device or in sections at a predetermined location of the orthopedic device, such as a top or proximal end. The frictional material is preferably deposited along an inner surface of the orthopedic device. The support is arranged with a cuff that bears the frictional material, and can be folded over the orthopedic device during donning and doffing to disengage the frictional material from the body of the user. Upon a desired location of the orthopedic device on the user, the cuff can be reverted to a position allowing for engagement of the frictional material to the body of the user. 
     In these and other possible embodiments, the problems of orthopedic devices including flexible orthopedic devices and sleeves being ineffective at migration control and/or difficult to don/doff, offering ineffective patella support, and being ineffective at mitigating pathologies such as osteoarthritis, are addressed and mitigated. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features, aspects, and advantages of the present disclosure will become better understood regarding the following description, appended claims, and accompanying drawings. 
         FIG. 1A  is a front elevational view of an embodiment of a knee support according to an orthopedic device. 
         FIG. 1B  is a side elevational view of the embodiment of  FIG. 1 . 
         FIG. 2A  is a detail view of a material structure in an embodiment of an orthopedic device. 
         FIG. 2B  is a detail view of another material structure in an embodiment of an orthopedic device. 
         FIG. 2C  is a perspective view of another material structure in an embodiment of an orthopedic device. 
         FIG. 2D  is a detail view of the detail IID when the orthopedic device is in extension. 
         FIG. 2E  is a detail view of the detail IID when the orthopedic device is in flexion. 
         FIG. 3A  is a side elevational view of another knee support according to an embodiment of an orthopedic device in a disengaged configuration. 
         FIG. 3B  is a front elevational view of the embodiment of  FIG. 3A  in an engaged configuration. 
         FIG. 4A  is a side elevational view of another knee support according to an embodiment of an orthopedic device in a disengaged configuration. 
         FIG. 4B  is a front elevational view of the embodiment of  FIG. 3A  in an engaged configuration. 
         FIG. 4C  is a schematic view of the embodiment of  FIG. 4A  showing a variation of an upper cuff in a disengaged configuration. 
         FIG. 4D  is a schematic view showing a frictional material pattern. 
         FIG. 4E  is a schematic view of a variation of a frictional material pattern. 
         FIG. 5  is a front elevational view of another embodiment of a knee support according to an embodiment of an orthopedic device. 
         FIG. 6A  is a front elevational view of another embodiment of a knee support according to an embodiment of an orthopedic device. 
         FIG. 6B  is a side elevational view of the embodiment of  FIG. 6A . 
         FIG. 7A  is a perspective view of another embodiment of a knee support according to an embodiment of an orthopedic device. 
         FIG. 7B  is a perspective view of a variation of the knee support of  FIG. 7A . 
         FIG. 8A  is a plan view of a knee support according to an embodiment of an orthopedic device in an open configuration. 
         FIG. 8B  is a plan view of a patella buttress for use in the aforementioned embodiments of knee supports according to an embodiment of an orthopedic device. 
         FIG. 8C  is an elevational view of a stay for use in the aforementioned embodiments of knee supports according to an orthopedic device. 
         FIG. 9  is an elevational view of pull tabs according to an embodiment of an orthopedic device. 
         FIG. 10  is an elevational view of pull tabs according to another embodiment of an orthopedic device. 
     
    
    
     In the figures, similar elements are provided with similar reference numbers. The drawing figures are not drawn to scale, or proportion, but instead are drawn to provide a better understanding of the components, and are not intended to be limiting in scope, but provide exemplary illustrations. 
     DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS 
     A. Fabrication of Various Embodiments 
     Various embodiments of the orthopedic device may utilize flat knitting, which allows production of textile structures into a final desired shape so there is no cutting and very minimal waste. Flat knitted elements are formed directly in the desired three-dimensional shapes or modular panels, which can help avoid the need to use additional support structures. 
     In engineering the stitches to stretch, restrict, pad, or contour to body shapes, using multiple types of yarns and/or combined stitch patterns at strategic placements, several desired performance characteristics can be localized into performance zones within a single, unitary construction. Various pockets, channels, and tunnels can be formed by the knitting to introduce: restrictive stays, pads, hot/cold packs, hyper elastic materials, inflatable pouches (liquid or air), webbing, hardware, and/or other customizable elements of bracing and support. Inflatable areas in the knit pouches can exert pressure and force on the desired areas and are customized to a patient&#39;s condition. 
     Embodiments of the functional knit orthopedic device preferably form a knitted textile support having a shape created on a knitting loom including, but not limited to, various warp knitting, circular knitting, or weft (flat) knitting processes. 
     Embodiments of the functional knit orthopedic device may take the form of a garment. Support areas may include several textile elements combined into one textile support panel with unitary construction or a group of modular panels for treating a medical indication. The body of the textile panel or panels provides for biomechanical range of motion, compression, and therapeutic elements integrated into a single panel, or panels that may form a garment. Three-dimensional flat knitting allows production of these textile structures into a final desired shape to avoid cutting and waste. 
     Each panel or series of panels may have areas of gradient levels of stretch, flexure, rigidity, and restrictive elements integrated into the fabric by mapping the levels of motion or restriction required for a medical indication. This is achieved through a corresponding system of knit stitching techniques that start with yarns. Knit stitching techniques create varying degrees of elasticity, rigidity, open channels, tunnels, and intarsia zones of specialized yarns integrated into the base fabric. The first area of knitting may be formed of a first stitch configuration, and the second area may be formed of a second stitch configuration different from the first stitch configuration to impart varying textures or properties to a surface of the textile element. These properties may include anti-bacterial, cooling, warming, elasticity, rigidity, compression, wicking, and/or color. 
     The knitted base of the device can comprise natural and/or synthetic yarns: silk, wool, polyester, nylon, olefin, and interlaced with specialty yarns: moisture management, elasticized, fusible, metallic, Kevlar, silicone, and other types of performance yarns knit into fully fashioned, textured, intarsia, or three-dimensional regions and appendages such as connected tubes, circles, open cuboids, straps, spheres, and other integrated knit shapes. 
     Flat knitted elements may be formed directly in the desired three-dimensional shapes or modular panels, which can help avoid the need to use additional support structures and emerge from the machine ready to be sewn together, advantageously saving on manufacturing costs. This fully fashioned knitting technique adds or drops stitches to create custom two- and three-dimensional shapes appropriate to the desired finished garment structure. 
     The intarsia areas may comprise threads or yarns, which are isolated into specialized zones, using silicon, Kevlar, fusible, nylon monofilament, Dynema, spandex, and/or other specialty performance yarns knit into the fabric to enable that region to perform a function. These areas can be arranged into any flat, textured, or three-dimensional shape required for load mapping the garment for the medical indication. 
     The load mapped zones may be further achieved by combining knit structures (knit, tuck, miss), transferring loops, dropping or adding needles, segmenting takedown in varying rates across the width of the garment fabric, varying structural elements, inlaying yarns, weft insertion, direct feed, warp insertion, and varying speed of yarns fed into the system. 
     Besides standard knitting feeders, several types of specialized knitting feeders may isolate, apply, and integrate these yarns into the base fabric of this garment: intarsia feeders, in-lay, direct feeders, and plaiting feeders. With the plaiting, the yarn may lie in the isolated area but only on the face or the back of the fabric. 
     B. Biomechanics of Various Embodiments 
     Control of joint range of motion includes motion inhibition, restriction, or prevention. This may be obtained through altering tension in a garment on a tangent to the skin controlling motion through shear loads (at a tangent to the skin). Control of joint range of motion and soft tissue may be assisted through compression or loading, at or near a normal direction to the surface of the skin and/or garment. 
     In embodiments of the orthopedic device, normal motion may be disrupted by an intimately fitting garment with restrictive bands integrated therein for constructing the functional knit orthopedic device. The restriction may be created through altering both the yarn and the weave of the fabric. The interface between fabric and skin can vary. Some areas can be low stretch and have high friction or tackiness bonding the fabric to the skin. These regions form an anchor for stabilization of the garment to the core and the extremity. 
     Other textile areas can have high stretch and offer low friction, allowing the body segment to move freely. By carefully selecting the anchor zones and orienting restrictive bands within the textile, embodiments can provide restriction or guidance to the joint in question, preventing injurious movement and even encouraging safe motion strategies about the joint. 
     C. Definitions 
     Numerous orthopedic device embodiments and components for use therewith are described herein, with particular focus given to flexible orthopedic devices and/or sleeves, and components directed to joints, in particular the knee joint and surrounding areas. The orthopedic device embodiments may serve in protective, preventative, or remedial capacities. While the orthopedic device is described within the context of a preferred embodiment that is directed to the knee, many of the features described herein may be extended to various orthopedic devices and components that secure other joints and body parts. Other flexible orthopedic devices and sleeves may comprise sleeves and devices comprising neoprene and/or other textiles and materials, and may include other tubular configurations or other shapes and configurations as well. 
     The orthopedic device embodiments and components for use therewith may be dimensioned to accommodate different types, shapes, and sizes of human joints and appendages. In addition, embodiments may be modified to orient principal forces exerted by strap systems of the embodiments at any desirable location to secure the device onto a leg in order to stabilize the joint. 
     The knee joint comprises two joints, lateral and medial, between the femur and tibia, and one arthrodial joint between the patella and femur. The primary movements of the knee comprise flexion, i.e., rearward rotational movement of the tibia relative to the femur (the completion of flexion ideally resulting in a fully bent leg), and extension, i.e., forward rotational movement of the tibia relative to the femur (the completion of extension ideally resulting in a fully straightened leg). 
     For explanatory purposes, each orthopedic device embodiment or component thereof described herein may be divided into sections which are denoted by general anatomical terms for the human body. Such anatomical terms are provided to distinguish various elements of the device embodiments from one another, but which are not to be considered to limit the scope of the disclosure. 
     Each of these terms may be used in reference to a human leg, by way of example, which is divided in similar sections with a proximal-distal plane generally extending along the meniscus of the knee between the femur and tibia. The terms “proximal” and “distal” generally refer to locations of the device that correspond to the location of the leg relative to the point of attachment of the leg to the body. The terms “upper” and “lower” may be used in combination with “proximal” and “distal” to connote gradations in location of “proximal” and “distal.” The location where the device corresponds to the knee joint is used herein to generally delimit the proximal and distal sections of the device. 
     The embodiments of the orthopedic device can also be considered to fall within “anterior” and “posterior” sections of an anterior-posterior plane. The anterior-posterior plane generally corresponds to the coronal or frontal plane of a human leg which lies along the central longitudinal axis of a body. A posterior side or element is therefore located behind this anterior-posterior plane, whereas an anterior side or element is located in front of the anterior-posterior plane. 
     The terms “inwardly” or “inner” commonly used herein to distinguish the side of the device that may be directed to the posterior side of the device and specifically adjacent to the leg of the wearer of the device. Contrariwise, the term “outwardly” or “outer” are used to denote the side of the device that is opposite to the inwardly side. 
     The terms “medial” and “lateral” are relative terms that are generally understood as indicating location with respect to the midsaggital plane or midline. Therefore, elements that are located near the midline are referred to as “medial” and those elements that are further from the midline are considered to be “lateral.” The term “central” is used to denote the area along the midline of a joint thereby dividing and sharing regions of the medial and lateral regions. 
     The terms “rigid” and “flexible” may distinguish characteristics of portions of certain features of the orthopedic device. The term “rigid” should denote an element of the device is devoid of flexibility. Within the context of frame or support members or shells that are “rigid,” it should indicate that they do not lose their overall shape when force is applied, and they may break if bent with sufficient force. The term “flexible” should denote that features are capable of repeated bending such that the features may be bent into retained shapes or the features retain no general shape, but continuously deform when force is applied. 
     D. Detailed Description of Various Embodiments 
     In any of the following embodiments, the features discussed with one embodiment may be extended to any of the other embodiments. The embodiments may include any of the features discussed in U.S. patent application Ser. No. 14/247,613, filed Apr. 8, 2014, and published as U.S. patent application publication no. 2014/0303534, published on Oct. 9, 2014, and incorporated by its entirety. 
     Referring to  FIGS. 1A and 1B , an orthopedic device  100  is arranged as a knee support, in this particular embodiment as a functionally knit orthopedic device. While the embodiment in  FIGS. 1A and 1B  depicts a functionally knit orthopedic device, the teachings of the disclosure are equally applicable to other types of flexible orthopedic devices and orthopedic devices in general. The knee support  100  includes a main body panel arranged in this embodiment as a knit tubular sleeve  101  having first and second regions  102 ,  104 ,  105  with different elasticities. The first and second regions  102 ,  104 ,  105  are continuously knit to one another to have a continuous structure without interruptions. The first and second regions  102 ,  104 ,  105  are integrally knit to one another with the threads or yarns interwoven to one another rather than forming sections stitched to one another by additional threads or yarns. While integrally knit to one another, the first and second regions  102 ,  104 ,  105  may be considered discrete relative to one another because they are demarcated relative to one another by their properties, such as elasticity and/or color. Alternatively, the first and second regions  102 ,  104 ,  105  may gradually transition into one another due to sharing of certain properties of their knit, such as including shared elastic yarns. While in this embodiment the main body panel is arranged as a tubular sleeve  101 , other configurations and shapes may be suitable. 
     A tension band  112  is integrally formed and functionally knit with the first and second regions  102 ,  104 ,  105 . While the tension band  112  is functionally knit with the first and second regions  102 ,  104 ,  105  in this embodiment, tension band  112  may be adapted to be attached in any suitable way to other types of flexible orthopedic devices and orthopedic devices in general. The tension band  112  has a gradient region  114  dissipating into at least one of the first and second regions  102 ,  104 ,  105  to gradually taper into the first and second regions  102 ,  104 ,  105  toward first (proximal) and second (distal) ends  134 ,  136 . Between the first and second ends  134 ,  136 , the tension band  112  is preferably discrete in that it is clearly delineated from the first and second regions  102 ,  104 ,  105  without the dissipation. The tension band  112  may be arranged to extend about a patella region  108  of the knee support to improve support and tracking of the patella during physical activity. 
     The tension band  112  may lack or have minimal elasticity, such that it does not have or has only limited amounts of elastic yarns. Alternatively, the tension band  112  may be formed by yarns having more stiffness than yarns used to form the first and second regions  102 ,  104 ,  105 . 
     The tubular sleeve  101  may define a third region  106  having a different elasticity than the first and second regions  102 ,  104 ,  105 . The second region includes first (upper) and second (lower) portions  104 ,  105 , preferably formed adjacent the first and second ends  134 ,  136 , and operate as anchors to the dissipating portions  114  of the tension band  112 . They may have a greater rigidity or elasticity than the first region  102 , and may be on a medial or lateral side of the knee support  100 . The third region  106  is preferably between the first and second portions  104 ,  105  to enable better bending of the knee support  100  in view of the greater rigidity of the first and second portions  104 ,  105 . 
     The third region  106  includes a popliteal portion  126  and has a plurality of reinforcement bands  128  for modifying the flexibility of the popliteal portion  126 . The first and third regions  102 ,  106  may have generally the same elasticity at certain portions thereof. According to the embodiment of  FIGS. 1A and 1B , the third region  106  at the popliteal region  126  has a different elasticity than the first region  102  due to the reinforcement bands  128 . 
     The patella region  108  is separate from the first and second regions  102 ,  104 ,  105 . The patella region  108  forms an opening  110  and may have a panel  122  extending over the opening  110  to provide protection and proprioception for a user. The panel  122  may have elasticity greater than the first and second regions  102 ,  104 ,  105  so as not to inhibit bending of the patella. As an alternative, the panel  122  may have greater rigidity to restrict bending of the knee and offer enhanced support. The panel  122  may be continuously knit with the other features, or selectively removable from the tubular sleeve  101 , such as from an inner surface of the orthopedic device  100 . 
     The patella region  108  may have a bolster  116  formed around the opening  110  and protruding outwardly a distance  130  from a profile  132  of the tubular sleeve  101 . The bolster  116  may include padding embedded within the tubular sleeve  101 . The bolster  116  may taper toward the opening  110  and have a greater height away from the opening  110 . The bolster  116  may have a variable outer radius extending from the opening  110 . The bolster  116  may have a greater upper height  138  toward the first end  134  than a lower height  140  toward the second end  136  of the tubular sleeve  101 . The bolster  116  may include padding and reinforce and protect the knee of a user while functioning in combination with the tension band  112  to provide support to the user&#39;s knee during gait. 
     The tubular sleeve  101  may have a circumferential band  118  arranged about an open first end portion  134  of the tubular sleeve. The circumferential band  118  may have different elasticity than the first and second regions  102 ,  104 ,  105 , and preferably has significant elasticity with retaining properties functionally similar to a circumferential strap without the specific need for a strap to retain the knee support  100  on the leg of a user. 
     A binding  120  is provided about an open first end  134  of the tubular support  101  and terminates the circumferential band  118 . The binding  120  terminates the knee support  100  at a peripheral edge and protects the fabric of the knee support  100  from unraveling or damage. The binding  120  may be integrally knit with the circumferential band  118 . 
     A stay  124  is located between first and second ends  134 ,  136  of the tubular support  101  to provide support for articulation of a knee support  100 . The stay  124  may be embedded within the tubular support  101  or may be formed by stiffer knit or a combination of a support element such as a plastic strip and unique knit for forming the stay  124 . 
       FIG. 2A  shows an exemplary knit structure  111  formed from a knit material or knitting  113 . The knit structure  111  includes a plurality of apertures having different sizes  115 ,  117 ,  119  and formed from the knit material  113 . A first set of apertures  115  is smaller than second and third sets of apertures  117 ,  119  and has less elasticity than the second and third sets of apertures  117 ,  119 . 
       FIG. 2B  shows another exemplary knit structure  121  having a plurality of different knit patterns  123 ,  125 ,  127 . A first knit pattern  123  surrounds a plurality of sections of second and third knit patterns  125 ,  127 . The first knit pattern  123  may have different properties than the second and third knit pattern  125 ,  127 . The first, second, and third knit patterns  123 ,  125 ,  127  may be distinguishable from one another on the basis of their color, elasticity, or a tightness of their knit. 
       FIG. 2C  exemplifies another knit structure  141  in a knee support  100 . In this embodiment, the knit structure  141  comprises different zones, such as first  142 , second  143 , and third  144  zones, that have different colors. Each zone  142 ,  143 ,  144  may have first and second layers of material  145 ,  146  (or outer and inner), which may be constructed from differently colored knitted structures, for example black and blue to obtain a visible contrast from each other. 
     For example,  FIG. 2D  shows the knee support  100  in extension whereby the first and second zones  142 ,  143  are not significantly tensioned over the knee.  FIG. 2E  shows the knee support  100  in flexion and tensioned or stretched over the knee whereby the contrast between the first and second zones  142 ,  143  is substantially more prominent due to a greater separation of discrete sections of the first layer  145 , such as columns or rows of the first layer  145  of material, and the revealing of the knitted structure of the second layer  146  between the first knitted structure  141 , in that one can easily observe a contrast between the first and second layers of material  145 ,  146 , whereas the contrast of such first and second layers  145 ,  146  of knitted material in  FIG. 2D  is minimal or non-existent. 
     The contrast of the layers offers a “shine-through” effect that provides a more aesthetic appearance of the knee support  100 , particularly as the knee support  100  undergoes tensioning and movement of the limb upon which it is worn. The shine-through effect offers a unique appearance to the knee support  100  that enables the manufacturer to distinguish its knee support  100  over other orthopedic devices. The contrast is not limited to colors of the knitted material, but can also relate to different finishes (stain, sheer, gloss) of the knitted material. 
     In this way, the first and second layers  145 ,  156  may further advantageously provide for different properties of moisture wicking, breathability, and heat transfer as required. For example, the first layer  145  may provide a tighter weave pattern to resist dirt and liquids from outside the orthopedic device to maintain cleanliness, while the second layer  146  may provide enhanced breathability for comfort. Alternatively, the first layer  145  may be configured to have less elasticity than the second layer  146 , such that when the knee support  100  is bent in flexion, the first layer  145  provides enhanced compressed against the joint. Numerous advantageous arrangements of the first and second layers  145 ,  146  can be similarly envisioned. 
       FIGS. 3A and 3B  illustrate a variation of the orthopedic device of  FIGS. 1A and 1B . In the orthopedic device  150 , an upper cuff  152  is secured to a tubular body  151 . The upper cuff  152  is arranged to provide migration control, which may be accomplished in a variety of ways, but is nonetheless to be disengaged during donning, doffing, and fitting of the orthopedic device  150  such that the orthopedic device  150  may be easily donned or doffed without sacrificing the advantages of the migration control. 
     In the illustrated example, the upper cuff  152  defines a frictional surface from a frictional material  153  that is arranged to engage the skin of the wearer and maintain the tubular sleeve  151  on the leg. An example of the frictional material  153  is silicone that is applied to the inner surface of the cuff  152  (when engaging the skin). Alternatively, the upper cuff  152  may be arranged or suitably knit in a manner that provides radial compressive forces about the leg. 
     The upper cuff  152  is adapted to flip over an upper end portion of the tubular sleeve  151  during donning. For example, upper cuff  152  defines a first edge  160  which forms an upper edge to the orthopedic device  150  when the upper cuff  152  is in an engaged configuration for normal use (as in  FIG. 3B ), and the first edge  160  is arranged to flip over the tubular sleeve  151  when the upper cuff  152  is in a donning/doffing or disengaged configuration (as in  FIG. 3A ). A folding portion  156  forms a joint about which the upper cuff  152  folds over the tubular sleeve  151 , and generally demarcates where the frictional material  153  terminates. The upper cuff  152  is arranged such that when the upper cuff  152  is folded over the tubular sleeve  151 , the upper cuff  152  is adjacently against the tubular sleeve  151 , wherein an outer surface of the upper cuff  152  snugly abuts a portion of an outer surface of the tubular sleeve  151  due to its radially compressive construction. 
     The orthopedic device  150  may include a lower cuff  154  arranged similarly to the upper cuff  152 , for migration control of the orthopedic device  150  when in an engaged configuration. The lower cuff  154  may include a frictional material, and is arranged to flip over the tubular sleeve  151  about folding portion  158 . When in an engaged configuration, the first edge  162  of the lower cuff  154  forms a lower edge of the orthopedic device  150 . When in a disengaged configuration, the folding portion  158  forms a lower edge of the orthopedic device  150 . 
     In order to facilitate donning of the orthopedic device  150 , handles  164  may be provided so as to extend from the tubular sleeve  151  to assist in pulling the orthopedic device  150  about a leg. As the knitted structure of the tubular sleeve  151  is intended to snugly secure about the leg, and in view of the need to tension the orthopedic device  150  about differing circumferences of the leg, the handles  164  enable the user to position the orthopedic device  150  in a suitable location to maximize the benefit of the orthopedic device  150 . The handles  164  may include an opening  166  for insertion of fingers to aid the user in gripping the handles  164 , which is particularly advantageous when the user is infirm or there are significant circumference differences of the user&#39;s leg, as handles  164  offer a user better purchase than trying to grip the tubular sleeve  151 . 
     The handles  164  also advantageously prevent a user from pulling directly on the tubular sleeve  151 , thus preventing damage thereto. Pulling on handles  164  rather than tubular sleeve  151  is also more intuitive and simple for users, as doing so is less likely to result in undesired rotation of the orthopedic device  150  during donning. By locating the handles  164  on an inner surface of the tubular sleeve  151 , damage is averted as the handles  164  are less likely to accidentally catch on objects as a user moves about, and the upper cuff  152  is better able to fold over the tubular sleeve  151  for donning and doffing without interfering with the use of the handles  164 . 
     The tubular sleeve  151  may define band segments  168 ,  170  that are reinforced or have an elasticity or omit elasticity in line with the contours of the handles  164 . For example, the band segments  168 ,  170  are inelastic or substantially inelastic so the tubular sleeve  151  can be suitably, sufficiently, and generally uniformly tensioned about the leg, as it is readily understood from the other embodiments described herein that there are elastic and flexible regions belonging to the orthopedic device  150 . 
     The handles  164  may be extensions of the knitted band segments  168 ,  170  and may flexibly extend from the tubular sleeve  151 , or alternatively may be secured to the tubular sleeve  151  such as along the upper folding portion  160 . In a variation, as depicted in  FIG. 3A , the handles  164  may be slidably mounted to the tubular sleeve  151  by internal loops  172 ,  174  on the tubular sleeve  151 . When not in use, the handles  164  may retract relative to the tubular sleeve  151 , and when desired for use, the handles  164  can be extended relative to the tubular sleeve  151 . Particularly, if an upper cuff  152  is not provided with the orthopedic device  150 , the handles  164  can still be used for donning the orthopedic device  150 . 
     The orthopedic device  150  includes a stay  176  generally formed by reinforced knitting on the tubular sleeve  151 . The stay  176  may be knitted over the tubular sleeve  151  by different, stiffer and resilient yarns or a combination thereof, or may be knitted together with the remainder of the tubular sleeve  151 . 
     The orthopedic device  150  omits features in a region directly adjacent to upper cuff  152  such that upper cuff  152  can be folded over to be adjacently against tubular sleeve  151  without interference from other features. 
       FIGS. 4A and 4B  represent another embodiment of an orthopedic device  180  having an upper cuff  182  in combination with a resilient stay  184  that is provided in combination with a main body panel arranged in this embodiment as a tubular sleeve  181 . In this embodiment, the upper cuff  182  includes a frictional material  183  located on a surface thereof and arranged to engage the skin of the user similarly to the embodiment of  FIGS. 3A and 3B . The stay  184  is formed by plastic or metal and has resilient properties adapted to resisting flexion of the orthopedic device  180 , and extends between upper and lower ends of the orthopedic device  180 . The stay  184  incorporates at its upper end a handle  186  that is integrated therewith. The handle  186  includes a head portion  188  configured for facilitating grasping with padding  190  located along a surface of the handle  186  adjacent the user&#39;s skin. 
     By incorporating the handle  186  with the stay  184 , preferably on medial and lateral sides of the orthopedic device  180 , rotation of the orthopedic device  180  about the user&#39;s leg can be prevented during donning. Indeed, once the upper cuff  182  is flipped about an upper folding portion  194  into an engaged configuration with an upper cuff edge  192  forming the upper edge of the orthopedic device  180 , the upper cuff  182  prevents migration and rotation of the orthopedic device  180  on the leg. Contrariwise, when the upper cuff  182  is in a disengaged configuration, the upper cuff  182  is folded over tubular sleeve  181  so as to be adjacently against the tubular sleeve  181 , due to the upper cuff  182  having radially compressive properties. In this configuration, an outer surface of the upper cuff  182  snugly surrounds a portion of the outer surface of the tubular sleeve  181 , which is possible due to other features of the orthopedic device  180  being spaced downwardly from the upper cuff  182 . 
     The frictional material  183  may be provided in different forms. In the example of  FIG. 4A , the frictional material  183  defines a band  196  that generally circumferentially extends about the inner surface of the upper cuff  182 . The band  196  may include a texture  198  that may form a plurality of openings, raised surfaces, random texture, or other textures that improve comfort for the user. In the embodiment of  FIG. 4A , a preferred frictional material  183  is silicone, in part due to its skin adhering properties and it enabling gentle roll-off when doffing the orthopedic brace  180  and therefore folding the upper cuff  182  over the tubular sleeve  181 . Other materials are envisioned providing similar properties. 
     In an alternative embodiment, the cuffs in the aforementioned embodiments may be formed by knitted silicone. As silicone has skin tackiness properties enabling gentle roll-off and roll-on, while having proven migration control characteristics, any of the embodiments may include silicone knit regions, whether by intarsia, terry stitch, waffle, circumferential areas, or other suitable applications. An example of silicone knitting is discussed in U.S. patent application Ser. No. 15/219,772, filed on Jul. 26, 2016, and incorporated herein by reference. 
     Uses of the knitted silicone include suspension, as in the aforementioned embodiments, massaging effects, and capture of bony and muscle anatomies. For suspension the knitted silicone may be at the top and/or bottom of a tubular brace, as in the upper and lower cuffs. The knitted silicone may be located along the length of the tubular brace, in which case it is best to have it in the same plane as the bending of the joint occurs, where shortening/lengthening does not occur. For example, in the knee, this would be along the medial and lateral side. 
     In another use of knitted silicone, the knitted silicone areas may provide a massaging effect, such as around the Achilles tendon, in the case of Achilles tendonitis. Silicone knit areas can be used for massaging, as the silicone knit areas are soft and do not exert any painful pressure, while evenly distributing pressure. The massaging effect may be provided by intarsia or terry knit in desired areas of the orthopedic device, while increasing in grade of an area to increase blood flow. 
     The knitted silicone can be arranged for capturing key bony anatomies through the surface of the skin. The silicone area can capture, for example, the patella of the knee by relying on the compression and frictional features and localizing the silicone area about the patella. 
     The knitted silicone can be used to capture key anatomies, and can be knitted into the orthopedic device to take place of Kinesio-taping or as elastic therapeutic tape built into the knitted structure of the orthopedic device as a whole. For example, in the embodiments described herein, one of the zones or regions of different elasticity may include a zone or region that is formed by knitted silicone so as to stretch beyond the original length of the zone to create a pulling force on the skin by the frictional properties and recoiling of the knitted silicone zone when the orthopedic device is worn. Thus, knitted silicone zone can be pretensioned or otherwise modified to create traction or pulling forces on the skin in combination with its adhesive properties. 
     As understood in Kinesio-taping applications, the knitted silicone zones may have general shapes for different taping type uses. For example, an “l” shape may be used for small or linear places, a “Y” shape may be employed for larger muscles, and an “X” shape may be used for long and large muscles. 
     Knitting in silicone presents two major challenges: first, the silicone is very sticky, and second, the silicone is highly elastic. Taken together, these challenges make it difficult to knit with silicone. The reason is that when knitting, the stickiness of the silicone causes it to stretch greatly in an uncontrolled manner. Since yarn stretch is crucial to form when knitting, the finished product will be greatly variable, and the manufacturing unreliable. To prevent this, one can either limit the elasticity of the silicone or make it less sticky. 
     One way to limit the elasticity of the silicone is to extrude it around a nylon core. The nylon core fabric can be spun in such a way as to have elasticity ranging from 0% (completely inelastic) to 100% (able to stretch to double its length at rest) or beyond. This method permanently limits the elasticity of the silicone yarn. 
     Another way to limit the stickiness of the silicone is to spin a non-sticky yarn around the silicone core. The silicone yarn can then be freely knitted. The external yarn is then removed post-knitting, for example by dissolving it in hot water or through some chemical process. In this method, the silicone retains its stickiness and elasticity. 
     Yet another way of limiting the stickiness of the silicone is to coat it in an oil or non-sticky powder prior to knitting. This will reduce the stickiness of the silicone. However, like the previous method, the oil/powder coating will need to be removed post-knitting. Possibly, the method of removal may be as simple as washing the product in a washing machine. 
     As discussed above, parts of the orthopedic device can be knitted with silicone. This can be done in intarsia, where certain areas will then include silicone for functional benefits. This can also be done not in intarsia but in circumferential zones such as at the top and bottom edges. 
     The silicone knit can be done with multiple types of knit stitches. One stitch type may result in the silicone creating a relatively uniform area of contact. It may be beneficial to have only limited contact with silicone, so another stitch may only expose part of the silicone yarn, and create “dots” of silicone in the garment. It may also be beneficial to have as much contact with silicone as possible, so to create larger surface area, the stitch may be a so-called “terry” stitch. 
       FIG. 4C  exemplifies a variation of the upper cuff  182  in the folded or disengaged configuration, as in  FIG. 4A . In this embodiment, the handle  186  is a flexible loop  187  stitched generally along the upper folding portion  194 . A lower band  195  may be stitched or otherwise formed proximate the upper folding portion  194  to demarcate or delimit the folding of the upper cuff  182 . Lower band  195  and upper folding portion  194  advantageously function to signal to a user where the upper cuff  182  is to be folded, so that the upper cuff  182  and the attached frictional material  183  are (preferably) adequately and completely disengaged from the user&#39;s leg when folded over. The loop  187  may be anchored along or proximate the lower band  195 . 
     The upper cuff  182  has an upper band  193  that may have greater elasticity and reinforcement so as to apply greater circumferential pressure along a limb than the remainder of the upper cuff  182  or tubular sleeve  181 . For example, the upper band  193  may be provided with more elastic elements when knitted, may have a tighter knitted structure, or may have a thicker knitted structure. Additionally, the upper band  193  advantageously allows an outer surface of the upper cuff  182  to be adjacently against an outer surface of the tubular sleeve  181  when in the disengaged configuration, in that the upper band  193  may assist the outer surface of the upper cuff  182  to snugly abut or surround a portion of the outer surface of the tubular sleeve  181  when folded over, in part due to the radial compression of the upper cuff  182  and in particular the upper band  193 . The lower band  195  may likewise be modified to have a different knitted structure to facilitate folding and demarcating the extent of the folding of the upper cuff  182  over the tubular sleeve  181 . 
     To further facilitate the folding of the upper cuff  182  into the disengaged configuration, or otherwise the extent to which the upper cuff  182  is folded over the main body of the tubular sleeve  181 , at least an interior surface  197  of the upper cuff  182  may have a different color or knitted pattern than the tubular sleeve  181 ; for example, the tubular sleeve  181  may be black whereas the interior surface  197  is light blue. 
     While an upper cuff  182  is described, a lower cuff may be similarly structured in order to facilitate donning and doffing; that is, the lower cuff may likewise comprise bands specially configured to facilitate folding and demarcating the extent of the folding of the lower cuff over the tubular sleeve  181  in order to engage and disengage frictional elements. By configuring either or both of an upper cuff and a lower cuff to be engaged or disengaged at will by a user to facilitate donning/doffing of the orthopedic device, a key setback in orthopedic devices is overcome: the orthopedic device is able to be easily donned and doffed due to the disengaged configuration (wherein the frictional elements along the upper and lower cuffs do not abut the user&#39;s anatomy), but in the engaged configuration the frictional elements overcome the tendency of such devices to migrate along a user&#39;s leg, which tendency hinders the effectiveness of the device. 
     The interior surface  197  includes a frictional material  191  arranged in a pattern to balance friction between the upper cuff  182  and the intended limb of the wearer of the knee support with comfort and breathability for a user. For example, the frictional material  191  has a pattern of a circumferential array of discretely deposited sections  199  that are shaped to coincide of the knitted structure of the upper cuff knitted pattern  189 . In this example, the frictional material pattern is similar to columns of opposing triangles that generally follow columnar aspects of the knitted pattern  189 . In this example, the sections  199  are arranged so as not to impede breathability. The columns of the pattern of deposited sections  199  extend circumferentially about the interior surface  197  of the upper cuff  182 , leaving sufficient space between each column to ensure breathability and comfort by balancing the exposure of the knitted structure and frictional material  191  against the skin of the user. 
     While the frictional material  191  is shown as having a pattern that generally corresponds to the knitted structure of the upper cuff  182 , at least along the interior surface  197  thereof, the frictional material  191  may be provided in a pattern that does not correspond to the knitted structure. 
       FIG. 4D  exemplifies a band  203  that can serve as a frictional material  191  that is deposited along the interior surface  197  of the upper cuff  182 . The pattern of the frictional material  191  may or may not correspond to the upper cuff knitted pattern  189 . The band  203  may be formed separately from the knitted structure, and later applied to the interior surface  197  of the upper cuff  182 , whether or not corresponding to the pattern  189  of the knitted structure. The band  203  has sufficient spacing among discrete regions to ensure sufficient breathability for the user in that the pattern is arranged so as to generally universally correspond to knitted structures while not substantially impeding airflow. 
       FIG. 4E  is another example of a pattern  205  of frictional material. In this example, the pattern  205  defines a plurality of columns  207 ,  209 ,  211 ,  213 ,  215 ,  217  of discrete frictional elements  227 . In this embodiment, the pattern  205  has boundaries  223 ,  225  within which the pattern  205  is located, which lends itself to being applied only to discrete segments of a circumference of the upper cuff  182 . Alternatively, as in a cuff, the pattern may be provided to circumferentially extend about a cuff. In a preferred embodiment, the pattern  205  of frictional elements  227  comprises and/or is constructed of a knitted silicone or other tacky type thread. 
     The frictional elements  227  may be variably sized relative to one another in each column, and may comprise different spacings  219 ,  221  relative to one another, particularly if the pattern  205  is located on areas of an orthopedic device  200 , not just an upper or lower cuff, that require variable friction. In areas of greater need for frictional control, the frictional elements  227  may be larger and/or located closer to one another, and in areas with less need for frictional control the frictional elements may be smaller and spaced apart greater. In any situation, however, the variability of the pattern  205  may be adapted to variable frictional and migration control needs in an orthopedic device. 
     Even though frictional material may be contained in a cuff, of the type described above, it is often desirable for additional circumferential frictional control to prevent migration of the knee support on the leg of the user. Certain areas of the leg will lend themselves to including more migration control than others; for example, the anterior and posterior sides of the leg may require more frictional control, particularly in flexion and extension, than the medial and lateral sides of the leg. 
     In another embodiment depicted in  FIG. 5 , an orthopedic device  200  in a knee support includes a main body panel arranged in this embodiment as a knit tubular sleeve  201  having first and second regions  202 ,  204  with different elasticities. The first and second regions  202 ,  204  are continuously knit to one another. The second region  204  includes at least first and second gradient segments  206 ,  208  arranged for modifying elasticity of the tubular sleeve  201  from the first region  202 . The knee support  200  may include a third region  210  having different elasticity from the first and second regions  202 ,  204 , and may resemble the first and second portions  104 ,  105  of the embodiment of  FIGS. 1A and 1B . 
     The knee support  200  may include a patella region  218  defining an opening  220  in that each of the first and the second regions  202 ,  204  extend discretely about at least a portion of the patella region  218 . The patella region  218  may resemble the patella region  108  of the knee support  100  of  FIGS. 1A and 1B . 
     The knee support  200  includes a cable system  212  having at least one cable  214  slidably movable relative to the tubular sleeve  201 . At least one guide  216  may be integrally formed from the tubular sleeve  201  and is arranged for receiving the at least one cable  214  such that the at least one cable  214  slides within the at least one guide  216 . 
     In the embodiment, the cable system  212  is on an opposite side of the patella region as the first region  202 . The second region  204 , whether with or without the gradient  206 ,  208 , and the cable system  212  may interact with one another and may be tailored or adjusted to offer the requisite support for a user&#39;s patella. 
     The cable system  212  may include an adjustment system (not shown) that enables tensioning of the cable system  212 . Examples of adjustment systems may be found in U.S. patent application publication no. 2014/0303534, U.S. patent application publication no. 2013/0211304, published on Aug. 15, 2013, U.S. 2015/0032041, published on Jan. 29, 2015, and U.S. patent application publication no. 2015/0121657, published on May 7, 2015, each being incorporated herein by reference. 
     A slot  222  in the tubular support  201  is arranged for receiving a segment of the at least one cable  214 . The at least one cable  214  is configured to have a segment received within a thickness of the tubular sleeve  201 , and the adjustment system may take up or dispense a length of the at least one cable  214 . The slot  222  may be reinforced with a reinforcement element  224  secured to the tubular sleeve  201  about the slot  222 . 
     The cable system  212  preferably includes a plurality of cables  214  slidable relative to the tubular sleeve  201 . A plurality of guides  216  are secured to a surface of the tubular support  201  and each is arranged for receiving an individual one of the cables  214 . First and second guides  226 ,  230  may each be along a different segment of first and second cables  228 ,  232 , and the first and second guides  226 ,  230  may have different lengths. The cable system  212  is preferably configured in a predetermined configuration over a surface of the tubular support  201  such that the at least one cable  214  is constrained in location over the tubular support  201  by the at least one guide  216 . 
     The cable system  212  solves the problem of straps being difficult to use or adjust, and being cumbersome due to the straps straying from their intended location, tangling, or being damaged by external forces. By providing the cable system  212  with at least one cable  214  and at least one guide  216  defined by and/or integral with the tubular sleeve  201 , the problems of straps are avoided but the beneficial purposes thereof (i.e. compression in specific locations, unloading of joints, securely mounting the device on the limb) may be retained. 
       FIGS. 6A and 6B  illustrate another orthopedic device embodiment in a knee support  300 . As with foregoing embodiments, the knee support  300  includes a main body panel arranged in this embodiment as a knit tubular sleeve  301  having first and second regions  302 ,  304  with different elasticities. The knee support  300  has a patella region  310  defining an opening  334 , with each of the first and the second regions  302 ,  304  extending discretely about at least a portion of the patella region  310 . A bolster  332  is formed around the opening  310 , and the second region  304  extends from the bolster  332  toward an end portion of the tubular sleeve  301 . 
     The knee support  300  further has a hinge assembly  322  secured to the tubular support  301 . To accommodate the hinge assembly  322 , the tubular support  301  has first and second strut inserts  336 ,  338  secured to the tubular sleeve  301 . The hinge assembly  322  has first and second struts  326 ,  330  received by the first and second strut inserts  336 ,  338 . The strut inserts  336 ,  338  may be formed from a plastic material and laminated or stitched to the tubular support  301 , being disposed along an external surface of the tubular support  301 . The struts  326 ,  330  may be removable from the inserts  336 ,  338 , and the inserts  336 ,  338  offer selective placement of a desired hinge assembly  322 . 
     In a variation of the hinge assembly  322 , the first and second strut inserts  336 ,  338  are within a thickness of the tubular sleeve  301 . First and second openings  324 ,  328  are arranged for receiving first and second struts  326 ,  330  into the tubular sleeve  301 . 
     The tubular sleeve  301  may have a third region including first and second portions  306 ,  308  corresponding to the first and second struts  326 ,  330 . The first and second portions  306 ,  308  may have elasticity less than the first region  302 , and may resemble similar structures in foregoing embodiments. As with the foregoing embodiments, the first and second portions  306 ,  308  are discretely separate from one another. A popliteal region  340  is preferably between the first and second portions  306 ,  308  and has elasticity greater than the first and second portions  306 ,  308 . 
     The orthopedic device  300  has a cable system  312  including at least one cable  314  slidably movable relative to the tubular sleeve  301 , as in foregoing embodiments. The cable system  312  has at least one guide  316  connected to the tubular sleeve  301  and is arranged for receiving the at least one cable  314  such that the at least one cable  314  slides within the at least one guide  316  and is routed over the tubular sleeve  301 . The at least one guide  316  includes a plurality of guide segments  320  spaced apart from one another and exposing the at least one cable  314  therebetween. 
     A guide cover  318  covers an entirety of a segment of the at least one guide  316 . The cover  318  may be constructed as an adjustment device or anchor for the at least one cable  314 , and be adjustable in location over a surface of the tubular support  301 . The cover  318  may have a fastener, such as hook and loop, engageable with a corresponding fastener on the tubular support  301 . 
     As shown in  FIGS. 6A and 6B , the cable system  312  is arranged circumferentially about the tubular support  301 , and takes the place of a strap found in a conventional brace. The cable system  312  may cooperate with a circumferential band  342  to retain the knee support  300  on a leg of user, with the cable system  312  providing additional support to the circumferential band  342 . The cable system  312  may extend over the hinge assembly  322  to maintain the circumferential support without impeding use of the hinge assembly  322 . Alternatively, the cable system  312  may be routed underneath the hinge assembly  322  to exert circumferential tension over the leg of the user. 
       FIGS. 7A and 7B  illustrate another embodiment of an orthopedic device in this embodiment in the form of a functionally knit knee support  400  aimed for treating osteoarthritis of the knee. While the orthopedic device in this embodiment is a functionally knit orthopedic device, the teachings of the disclosure are equally applicable to other types of flexible orthopedic devices and to orthopedic devices in general. The knee support defines a main body panel arranged in this embodiment as a tubular sleeve  402 , and has first and second straps  404 ,  406  arranged to spiral about an outer surface of the tubular sleeve  402 , and intersect at a predetermined location. The operation and purpose of the straps  404 ,  406  for treatment of osteoarthritis of a knee are described in U.S. Pat. No. 7,198,610, granted Apr. 3, 2007, and incorporated herein by reference. The location of the intersection of first and second straps  404 ,  406  advantageously overcomes the problems of existing straps which intersect over a hinge directly on a medial or lateral side of the brace, which location is not effective for treating osteoarthritis. 
     The knee support  400  includes a hinge support  410  located along at least one side of the knee support  400 , and extends into upper and lower regions of the knee support relative to a central or knee portion. The hinge support  410  is arranged to support or position a hinge  408 , and provides anchor areas  446 ,  448  for the first and second strap  404 ,  406 . The hinge support  410  defines sleeves  426 ,  428  for receiving portions of the hinge  408  to secure the hinge  408  relative to the tubular sleeve  402 , and enable removal of the hinge  408 . For example, a different type of hinge, such as a hinge having different stiffness or articulation (four-bar, polycentric, biasing bar), may easily replace an existing hinge. 
     The hinge support  410  may serve as anchor points for the first and second straps  404 ,  406 . According to the illustrated embodiment, the hinge support  410  is located along either the medial or lateral sides of the knee support  400 , and generally along the anterior-posterior plane. Indeed, the hinge support  410  extends between upper and lower regions of the tubular sleeve  402  along one of the medial and lateral sides of the knee support  400 . The hinge support  410  may be articulated at the anterior and posterior knee portions  422 ,  424  of the tubular sleeve  402  to accommodate a natural contour of a leg. 
     The hinge support  410  may be preferably more rigid than the tubular sleeve  402 , although it may be pliant to permit easy contouring of the knee support  400  to the leg of the user. Nonetheless, the hinge support  410  preferably provides greater stability for securing elements, such as straps and a hinge, than the knitted tubular support  402 . 
     In an example, the hinge support  410  is formed from a material having greater rigidity than the knitted structure of the tubular sleeve  402 . By way of example, lower or second ends  432 ,  436  of the first and second straps  404 ,  406 , are permanently or removably secured to a lower or second portion  448  the hinge support  410 . By “permanently” secured, it is intended to mean that it is not readily removable by a user, and from normal usage of the knee support  400 , a user cannot remove the lower end from the tubular sleeve  402  without significant difficulty. By “removably” secured, it is intended to mean during normal use a user can detach the lower end  432 ,  436  from the hinge support  410 . 
     In the configuration of being permanently secured, the lower ends  432 ,  436  may be pivotally secured to the hinge support  410 , and extend upwardly in a spiraling manner to an upper or first portion  446  on the hinge support  410 . Upper or first ends  430 ,  434  of the first and second straps  404 ,  406  are removably secured to the upper or first portion  446  of the hinge support  410 . Preferably, the upper or first portion  446  of the hinge support  410  comprises hook receivable material and the upper or first ends  430 ,  434  having corresponding hook material engageable with the upper or first portion  446 . To guide the first and second strap  404 ,  406 , a guide  435 , such as a loop, is proximate or at the upper or first portion  446 . The upper or first portion  446  is sufficiently sized to accommodate both upper or first ends  430 ,  434  without overlap. 
     The upper and lower portions  446 ,  448  may include first and second stays  438 ,  440  to provide reinforcement to the straps  404 ,  406 , and possible tension they may exert on the tubular sleeve  402 . The stays  438 ,  440  may be semi-rigid to provide additional support beyond the hinge support  410  and material of the tubular sleeve  402 . The stays  438 ,  440  may be permanently secured or removably secured to or within the hinge support  410 . The hinge  408  may overlap the stays  438 ,  440  whereby the stays  438 ,  440  may cover a greater portion of the tubular sleeve  402  than hinge arms of the hinge  408 , and may serve to distribute pressure exerted by the hinge arms. 
     The tubular sleeve  402  defines different regions of elasticity, wherein the tubular sleeve  402  includes a main panel  416  that generally possesses a baseline elasticity to comfortably and functionally support a leg. The tubular sleeve  402  includes an upper cuff  414  that may function and be structurally arranged similarly to aforementioned embodiments. The upper cuff  414  preferably has a lower band  412  that is located above the hinge support  410  so the hinge support  410  and stays  438 ,  440  it may contain do not interfere with folding the upper cuff  414  between the engaged and disengaged configurations, with a proximal edge  442  extending over the hinge support  410 . 
     The tubular sleeve  402  may include a first region of elasticity  418 , as in preceding embodiments, on the anterior side of the knee support  400 , and may be more rigid or having a contour to embrace or add further support to the knee over the main panel  416 . The tubular sleeve  402  may also include a second region of elasticity  420  along or in line with the hinge support  410 . The second region of elasticity  420  may be more rigid than the main panel  418 , and operates with the hinge support  410  to provide greater rigidity along a direction in which the hinge  408  extends. 
     Referring to the embodiment of  FIG. 7B , a variation of the knee support  400  of  FIG. 7A  includes angled extensions  450  extending from the hinge support  410  to accommodate the spiraling and angling of the first and second straps  404 ,  406 . A D-ring or other suitable attachment  452  extends from the extensions  450  and permits the first and second straps  404 ,  406  to secure over itself at first ends  454  to set the length of the straps  404 ,  406 . Although not depicted, the second ends of the straps  404 ,  406  may be similarly modified to secure onto themselves. 
       FIG. 8A  depicts an exemplary embodiment of an interior surface  502  of a main panel  501  of a knee support  500 . In this embodiment, the main panel  501  may be securable along longitudinal side portions  504 ,  506  to form a tubular structure. The interior surface  502  may support various stays, bolsters and pads, including stays  508 ,  510 , and a patella pad  512 . These stays, bolsters and pads may be removably secured or permanently secured to the main panel  501 . 
       FIG. 8B  depicts an exemplary patella pad  520  that may be removably or permanently secured to a knee support  500 . The patella pad  520 , as depicted showing an outer surface with the inner surface being generally planar in a flat configuration and adapted to be secured to the tubular sleeve of a knee support  500 , has peripheral relief portions  524 ,  526  that are provided for reducing pressure and improving flexure according to flexion and extension of a knee. 
     The top relief portion  524  has an arcuate cut-out  534  along the periphery and a corresponding concave relief  536 . This configuration provides pressure relief on top of the patella and negates pressure on the knee from above the patella. The lateral relief portions  526  likewise have an arcuate cut-out  538  and a corresponding concave relief  539 , which provides for better flexure of the patella pad  520 , and anatomically contours to the side of the knee during flexion of the knee. 
     The patella pad  520  defines an opening  522 , that may preferably have an oval and non-uniform shape with a greater width at an upper portion  523  and a narrower width at a lower portion  525 , to better receive and anatomically contour to the shape of a patella. Below the lower portion  525 , there is a segment formed as a patella tendon support zone  528  that leads to a lower extension  529  having an elongate recess  530  or concave relief on the patella ligament. The elongate recess  530  is recessed relative to the patella tendon support zone  528 , which is formed in part by a generally circumferential width of the patella pad  520  about the opening  522 . This structure advantageously allows the patella pad  520  to provide adequate support to a user&#39;s tibial tuberosity but mitigates undesired pressure points by means of the elongate recess  530 . 
     The generally circumferential width gradually tapers to the opening  522  or an inner periphery of the patella pad  520 , and yet further tapers to the outer periphery of the patella pad  520 , along which the relief portions  524 ,  526 ,  536  are located. The relief portions  524 ,  526 ,  536  are noted as having a concave configuration relative to the inner surface, and the portions outside of the concave configuration are generally convex relative to the inner surface. The relief portions  524 ,  526 ,  536 , by virtue of their concave configuration, provide desired flexibility to the patella pad  520  and mitigate pressure points between the patella pad  520  and a user&#39;s leg. 
     The patella pad  520  may define a grip pattern  532  that may be uniform or variable relative to the location of individual grip elements  533 . For example, the grip elements  533  may have a small size about the inner periphery of the patella pad  520  and the within the concave reliefs, relative to areas outside of these areas where the grip patterns may be bigger along the convex portions of the patella pad  520 . The grip pattern and elements  532 ,  533  advantageously prevent undesired translation of the patella pad  520  along the skin of a user. 
       FIG. 8C  exemplifies how a removable stay system  540  may be provided within the knitted structure of a panel  544  for an orthopedic device  500 . Specifically, the panel  544  may form a pocket  548  that can accommodate a removable stay  542  through a slit  546  providing access to the pocket  548 . The pocket  548  preferably has a profile that closely approximates the stay  542  so the stay remains securely and snugly maintained within the pocket  548 . 
     Turning now to  FIG. 9 , an elevational view of an embodiment of an orthopedic device is shown. In this particular embodiment, an ankle brace  600  is shown in an engaged configuration, comprising a main body panel arranged in this embodiment as a tubular body  601 , with an upper cuff  602  divided from the tubular body  601  by an upper folding portion  605 . An uppermost periphery of ankle brace  600  is defined by first edge  609 . Handles arranged in this embodiment as pull tabs  603  are attached to the ankle brace  600  at an attachment portion  604 , which may attach at a stay  606  similar to the foregoing embodiments and demarcated in this embodiment by a different fabric color and texture than surrounding portions of tubular body  601 . Pull tabs  603  may attach to the tubular body  601  by reinforcement stitching  607  and/or by adhesive  608 . 
       FIG. 10  depicts an elevational view of the embodiment of  FIG. 9  in a disengaged configuration, depicting in particular how stay  606  may be arranged to extend through tubular body  601  in a particular configuration in order to advantageously apply pressure along critical portions of a limb, in this embodiment a region proximate to the Achilles tendon of a user. This structure has the added advantage of providing an improved path for the handles arranged in this embodiment as pull tabs  603  to exert forces on the ankle brace  600 , thus avoiding damage to the ankle brace  600  during donning and doffing. 
     In any of the aforementioned embodiments and variations thereof, an orthopedic device may include straps for added function to the device. The straps can be external, or they may be knitted as cables or laces into the brace, as discussed above, or they can be knitted as zones of low elasticity into the brace. For external straps, markers may be provided on the strap to guide the user how to apply the strap or adjust the cables for tensioning or reducing tension in the strap. The markers can be knitted into the knitting of the orthopedic device or otherwise applied, such as by heat transfer. 
     In another embodiment, straps or bands can be laminated into or over the orthopedic device. The orthopedic device may be knitted in a manner including zones of hook receivable material or structure, and the corresponding strap may include hook material for engaging the hook receivable zone. Loops may be formed directly by the orthopedic device for guiding the strap or cables. 
     It is possible to knit the orthopedic device in such a way that the active components are only visible on the inside, while the outside of the brace is more uniform in appearance. This enables the user to see how the brace functions before donning, while not being “too flashy” when worn. 
     While the disclosure discusses embodiments for the knee and ankle, orthopedic device embodiments of the disclosure may be used with other limbs, joints and anatomical portions including the torso, shoulder, elbow, wrist/hand, hip, knee, and foot/ankle. 
     Not necessarily all such objects or advantages may be achieved under any embodiment of the invention. Those skilled in the art will recognize that the invention may be embodied or carried out to achieve or optimize one advantage or group of advantages as taught without achieving other objects or advantages as taught or suggested. 
     The skilled artisan will recognize the interchangeability of various components from different embodiments described. Besides the variations described, other known equivalents for each feature can be mixed and matched by one of ordinary skill in this art to construct an orthopedic brace under principles of the present invention. Therefore, the embodiments described may be adapted to orthopedic systems for securing, supporting or comforting limbs or other anatomy. 
     Although this invention has been disclosed in certain preferred embodiments and examples, it therefore will be understood by those skilled in the art that the present invention extends beyond the disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents. It is intended that the scope of the present invention disclosed should not be limited by the disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.