Abstract:
A tension strap to be used with any brand of ACL or OA functional knee bracing. The position, elasticity and versatility of the strap allow it to be used for patella support and to prevent vertical migration of the brace. The strap is placed over the anterior side of the face of the knee joint with the support buttress lying adjacent to the anterior edge of the patella and the support straps extended posteriorly to the upper arms and lower arms of the brace. The support straps are then pulled around the outside of the upper arms and lower arms of the brace and adhered back to themselves using hook and loop fastener material. Additional support tension can be applied to the patella through the buttress support by increasing tension through the support straps. The prevention of vertical migration of the knee brace is also achieved through the use of non-slip lining on the face of the tension strap that is in contact with the skin covering the knee joint and patella.

Description:
BACKGROUND OF INVENTION 
       [0001]    The present disclosure provides a tension strap for use with knee braces. The knee joint is one of the human body&#39;s most vulnerable joints to injury in sport, recreation, and physical labor. The patella femoral joint is a common site of pain and injury. The etiology of patella femoral pain can be traumatic or insidious in nature, but it is commonly the result of lateral force vectors acting on the patella. This lateral force vector can be a result of medial ligamentous injury (documented in studies and articles published by Dr. William P. Garth), tight lateral tissue, or poor biomechanical alignment (increased quadriceps angle, improper landing strategy, etc.). 
         [0002]    Several patella femoral braces are available on the market which focus on attempting to control the lateral displacement of the patella. These braces are specifically designed to control the tracking in a single plane for the Medial Patella Meniscus Ligament (MPML). However, the ability to control the MPML and also the Medial Patella Femoral Ligament (MPFL) is not currently available in conjunction with multiple instability rigid bracing. The present invention addresses both these ligament issues. 
         [0003]    Osteoarthritis (OA), Anterior Cruciate Ligament (ACL) and other functional braces are widely used by athletes and other individuals to protect the knee from injury, decrease stresses to healing tissue (postoperatively), and to decrease exacerbating factors with existing injuries. Several manufacturers produce functional braces designed to protect ligament tissue of the knee (primarily the ACL, but also the Medial Collateral Ligament (MCL) and the Posterior Cruciate Ligament (PCL)) as well as the articular cartilage of the knee (OA unloading braces). These braces are widely used in sports for the reasons mentioned above as well as for prophylaxis in high velocity/high impact sports (such as, but not limited to, football) and everyday patients with OA knee pain. Common mechanisms of injury these braces protect against include excessive valgus forces (a blow to the lateral knee), rotational forces (commonly internal rotation of the femur on the fixed tibia), shearing forces (anterior shear of the tibia on the femur) and unloading joint compartmental issues. However, these braces are only effective if the brace is properly aligned on the wearer&#39;s leg and with the patella femoral joint. 
         [0004]    Athletic trainers responsible for keeping these types of braces on the players during sporting events express frustration about the constant adjusting of the functional braces on the athletes during use, and often trainers and athletes resort to such ad hoc measures as taping the brace to the wearer&#39;s leg to keep the brace from falling down the leg. It is one object of the present invention to assure that such rigid OA and ACL braces will be in proper alignment while in use. Athletic trainers and coaches who have used prototypes of the present device of the disclosure are enthusiastic about the potential to solve this frustrating migration problem. 
         [0005]    A related problem results when applying rigid braces to larger patients. The leg shape often encountered in such patients is referred to as “upside down cone shaped leg” and results in rigid braces of common design sliding down the leg during use. This brace migration can be the result of hinge design not matching physiologic axis of rotation at the knee; muscle atrophy after injury, surgery or immobilization; or poor purchase (or fit) of off-the-shelf functional braces. 
         [0006]    The brace migration introduced by inherent design problems in the typical rigid brace is exacerbated by the fact that the rigid brace is supported by contracting, constantly moving muscle tissue. The present device of the disclosure solves the problem of brace migration by capturing the patella and skin of the knee and utilizing the forces that are present throughout flexion and extension keep the brace system suspended in the desired, proper alignment with the knee. The brace migration issues associated with hinge design, muscle atrophy, “upside down cone shape leg” and constantly moving muscle tissue have been overcome in several trials of prototypes of the present invention. 
         [0007]    Furthermore, clinical cases often require bracing to address other instabilities of the knee, such as, but not limited to, both patella femoral bracing and OA/ACL bracing. This can occur with an ACL tear or other injury concurrent with patellar subluxation/dislocation where the mechanism of injury is similar (valgus/external rotation of the leg). Another common occurrence is where the patient is performing rehabilitation activities after knee surgery, such as ACL reconstruction, and develops patella femoral pain, which is significant because patella femoral pain can inhibit muscle contraction and result in a difficult, lengthy rehabilitation process. In such instances of patella subluxation occurring in conjunction with multiple instabilities of the knee, it is an object of the present disclosure to provide a tension strap for use on rigid braces existing on the market today to simultaneously control patella instability problems and brace migration issues. Thus, the present disclosure provides a simple, cost effective mechanism to solve the problems of functional brace migration and the lack of existing products in the art that simultaneously address the multiple issues patella and knee instability while also addressing functional brace migration. Significant economies to the user are achieved because the device of the present disclosure can be applied to most any functional brace on the market without permanent modification to the functional brace, a fact most useful in situations where only temporary patella femoral support or anti-migration is needed, such as postoperative rehabilitation, sporting events, larger leg sizes, etc. 
       SUMMARY OF THE INVENTION 
       [0008]    The present disclosure provides a tension strap for use with knee braces, such as but not limited to, knee braces used for the pre- and post-injury support of the anterior cruciate ligament (ACL). The disclosed tension strap provides for at least one of the following functions: (i) prevention of vertical migration of the knee brace during use; and (ii) providing support to the patella (knee cap) which is not normally provided in existing braces. The disclosed tension strap provides for the prevention of vertical migration by pulling the hinges of the knee brace in towards the knee and through the grip provided by contact between the material of the tension strap and the skin of the user. In addition, the tension strap provides stabilization of and support to the patella by applying corrective forces to the patella to ensure proper patella alignment and dynamic tracking of the patella femoral joint. In one embodiment, the disclosed tension strap performs both functions. However, in an alternate embodiment, the tension strap may provide only one function, such as, but not limited to, prevention of vertical migration of the knee brace. 
         [0009]    The tension strap of the present disclosure also provides for increased efficiency in use of the knee brace compared to the methods known in the art. By providing a mechanism to prevent vertical migration of the knee brace, the tension strap eliminates interruptions in physical activity, most notably athletic contests, practices for those contests and rehabilitation activities, where a migrating knee brace has to be refitted to proper placement on the wearer&#39;s knee. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIGS. 1   a  and  1   b  are, respectively, anterior and posterior views of one embodiment of the tension strap of the present disclosure with buttress support member attached in final position on the knee brace and the knee brace worn on the user&#39;s right knee. While the design of the knee brace worn on the right knee is different from the design of the knee brace worn on the left knee, the tension strap is universal in fit for both right knee and left knee braces. 
           [0011]      FIGS. 2   a  and  2   b  are views, respectively of the bottom and top of one embodiment of the tension strap of the present disclosure with buttress support member. 
           [0012]      FIGS. 3   a  and  3   b  are, respectively, anterior and posterior views of one embodiment of the tension strap of the present disclosure with buttress support member prior to final attachment of the tension strap onto the knee brace (again illustrating a knee brace worn on the right knee of the user). 
           [0013]      FIGS. 4   a  and  4   b  are medial side views of one embodiment of the tension strap of the present disclosure showing, respectively, the unlooped and looped medial side support straps (again illustrating a knee brace worn on the right knee of the user). 
           [0014]      FIGS. 5   a  and  5   b  are lateral side views of one embodiment of the tension strap of the present disclosure with buttress support member showing, respectively, the unlooped and looped lateral side support straps (again illustrating a knee brace worn on the right knee of the user). 
           [0015]      FIGS. 6   a  and  6   b  are, respectively, anterior and posterior views of one embodiment of the tension strap of the present disclosure without buttress support member attached in final position on the knee brace (again illustrating a knee brace worn on the right knee of the user). 
           [0016]      FIGS. 7   a  and  7   b  are bottom and top views, respectively, of one embodiment of the tension strap of the present disclosure without a buttress support member. 
           [0017]      FIGS. 8   a  and  8   b  are, respectively, anterior and posterior views of one embodiment of the tension strap of the present disclosure without buttress support member prior to final attachment of the tension strap onto the knee brace (again illustrating a knee brace worn on the right knee of the user). 
           [0018]      FIGS. 9   a  and  9   b  are lateral side perspective views of one embodiment of the tension strap of the present disclosure without buttress support member showing, respectively, the unlooped and looped lateral side support straps (again illustrating a knee brace worn on the right knee of the user). 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0019]    Referring more particularly to the drawings,  FIGS. 1  ( a  &amp;  b ) and  6  ( a  &amp;  b ) show the tension strap  30  used in combination with a knee brace  20  worn on the leg  12  of a user. The knee brace  20  typically includes one or more proximal cuffs  28  engageable with the wearer&#39;s leg  12  above the knee  10  and one or more distal cuffs  29  engageable with the wearer&#39;s leg  12  below the knee  10 . The knee brace  20  typically has a pair of hinge assemblies ( 26 L and  26 M) disposed medially (M) and laterally (L) about the joint of the knee  10 . The proximal cuffs  28  of the knee brace  20  are typically connected to the pair of hinge assemblies ( 26 L and  26 M) by a pair of upper arms ( 22 L and  22 M) generally disposed medially and laterally about the knee  10  and leg  12 . The distal cuffs  29  of the knee brace  20  are also typically connected to the pair of hinge assemblies ( 26 L and  26 M) by a pair of lower arms ( 24 L and  24 M) also generally disposed medially and laterally about the knee  10  and leg  12 . 
         [0020]    As will be seen in  FIGS. 2  ( a  &amp;  b ), in one embodiment of the present invention, the tension strap  30  has three primary parts: (i) the body  40 , all or part of which engages all or part of the skin on the anterior side of the wearer&#39;s knee  10  and patella  14 ; (ii) a plurality of support straps ( 50 L and  50 M) (here shown as four in number) extending distally from the body  40  which engage the knee brace  20  at the distal ends  52 L and  52 M of the support straps ( 50 L and  50 M) in the manner later described; and (iii) a support buttress member  60  for the patella  14 . 
         [0021]    The body  40  is formed of a flexible, elastic material, such as, but not limited to, neoprene with unbreakable looped backing (ULP) on the outer surface of the body  40 . The inner surface  42  of the body  40 , being that surface of the body  40  that will contact the skin on the anterior side of the user&#39;s knee  10  in the manner later described, is of a non-slip material, such as, but not limited to, exposed neoprene or synthetic shark skin. 
         [0022]    The support straps ( 50 L and  50 M) are formed of a flexible, elastic material, such as, but not limited to, neoprene with unbreakable looped backing (ULP) on both sides of the support straps ( 50 L and  50 M). In one embodiment, the support straps ( 50 L and  50 M) and body  40  are affixed together by sewing, however, one skilled in the art will understand that the support straps ( 50 L and  50 M) and body  40  may be of unitary construction or may be affixed together by other like means. 
         [0023]    As shown in  FIGS. 1   a ,  2   a ,  3   a  and  5   a , the buttress support member  60  has a low elevational profile with an arcuate medial profile to substantially conform to the dimensions of the lateral circumference of the patella  14 . One skilled in the art will understand that the buttress support member  60  may also take the shape of a complete loop, circular or otherwise, such that the inside dimension of the buttress support member  60  will substantially conform to the dimensions of the entire circumference of the patella  14  and that the dimension of the body  40  and support straps  50  can be modified to accommodate a buttress support member  60  of different shapes. The buttress support member  60  is fashioned from a firm, flexible material, such as, but not limited to, thick rubber tubing. The buttress support member  60  is affixed to the inner surface  42  of the body  40  such that it will contact and provide support to the patella  14  in the manner later described. In one embodiment, the buttress support member  60  is encased within a guide pocket  62  that is arcuately configured with the outer dimensions of the buttress support member  60  and is secured to the inner surface  42  of the body  40  as described above). The exterior surface of the guide pocket  62 , being that surface of the guide pocket  62  that will contact the skin on the anterior side of the wearer&#39;s knee  10  in the manner later described, may be of the same non-slip material as is found covering the inner surface  42  of the body  40 . 
         [0024]    As shown in  FIGS. 1  ( a  &amp;  b ),  2  ( a  &amp;  b ),  3  ( a  &amp;  b ),  4  ( a  &amp;  b ) and  5  ( a  &amp;  b ), the lengths of the support straps ( 50 L and  50 M) are such to permit the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) to be wrapped or looped about the medially and laterally disposed upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the fashion later described. In one embodiment, the support straps  50 L to be affixed to the laterally disposed upper arm  22 L and lower arm  24 L of the knee brace  20  are shorter in distal length than those support straps  50 M that will be affixed to the medially disposed upper arm  22 M and lower arm  24 M of the knee brace  20  such that less distal elastic deformation will be experienced across the lengths of the laterally disposed support straps  50 L than that experienced by the medially disposed support straps  50 M, thereby anchoring the buttress support member  60  along the lateral aspect of the patella  14  and knee  10  during flexion of the knee  10  in the manner later described. 
         [0025]    As shown in  FIGS. 2  ( a  &amp;  b ), a patch of hook fastener material ( 54 L and  54 M) is affixed to the distal end ( 52 L and  52 M of each support strap ( 50 L and  50 M). In one embodiment, the outer dimensions of the patches of hook fastener material  54 L affixed to the distal ends  52 L of the support straps  50 L are contained within the outer dimensions of the outer surface of the support straps  50 L and may be affixed to the outer surface of the support straps  50 L by such means as gluing, sewing or through the use of double sided hook fastener material. In one embodiment, the patches of hook fastener material  54 M affixed to the distal ends  52 M of the medially oriented support straps  50 M append distally off the distal ends  52 M and are affixed to the support straps  50 M by use of alligator tabs also of hook fastener material that adhere to both the inner and outer surface of the support straps  50 M. However, it will be appreciated that the patches of hook fastener material  54 M may be affixed to the distal ends  52 M of the support straps  50 M by any manner of acceptable means. 
         [0026]    Because loop fastener material  56  is distributed about the proximal surfaces of each support strap ( 50 L and  50 M) and the outer surface of the body  40 , the support straps  50  (L and M) having been wrapped or looped about the medial and lateral upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the fashion later described, upon closing the looped support straps ( 50 L and  50 M), the patch of hook fastener material ( 54 L and  54 M) of each support strap ( 50 L and  50 M) will adhere to the loop fastener material  56  on the top surface of each support strap ( 50 L and  50 M) or the outer surface of the body  40 , thereby securing the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0027]    As shown in  FIGS. 1(   a  &amp;  b ),  3 ( a  &amp;  b ),  4 ( a  &amp;  b ) and  5 ( a  &amp;  b ), a self adhesive patch of hook fastener material ( 58 ) will also be applied to each of the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in a desired positions along the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  where the support straps ( 50 L and  50 M) will be wrapped or looped about and secured to the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the manner later described so as to anchor the vertical positions of the support straps ( 50 L and  50 M) about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0028]    Operation of the tension strap  30  is described with continuing reference to  FIGS. 1(   a  &amp;  b ),  3 ( a  &amp;  b ),  4 ( a  &amp;  b ) and  5 ( a  &amp;  b ). Prior to application of the tension strap  30 , the knee brace  20  is first fastened to the wearer&#39;s leg  12  in a normal fashion. As shown in  FIGS. 3(   a  &amp;  b ),  4   a  and  5   a , following the fastening of the knee brace  20  to the wearer&#39;s leg  12 , the body  40  of the tension strap  30  is placed over the anterior portion of the knee  10  with the inner surface  42  of the body  40  and the guide pocket  62  in contact with the user&#39;s skin so that the buttress support member  60  lying adjacent to the lateral edge of the outline of the patella  14  such that the location orientation of the buttress support member  60  applies the desired directional support forces to the patella  14 . The support straps ( 50 L and  50 M) are then inserted between the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  and the wearer&#39;s leg  12  and extended to the posterior side of the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . Self adhering patches of hook fastener material are disposed about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  for vertically anchoring the support straps ( 50 L and  50 M) at the locations at which the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) will be looped around the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0029]    As shown in  FIGS. 1  ( a  &amp;  b ), and  5  ( a  &amp;  b ), the distal ends  52 L of the support straps  50 L oriented on the lateral side of the knee  10  and the patella  14  are then pulled around the outside of the laterally-oriented upper arm  22 L and lower arm  24 L of the knee brace  20  and looped from the posterior side of the laterally-oriented upper arm  22 L and lower arm  24 L of the knee brace  20  towards the anterior side of the upper arm  22 L and lower arm  24 L of the knee brace  20  such that the loop fastener material  56  disposed about the surface of the support straps  50 L will adhere to the self adhering patches of hook fastener material  58  that have been disposed about the upper arm  22 L and lower arm  24 L of the knee brace  20 . The distal ends  52 L of the support straps  50 L oriented on the lateral side of the knee  10  and the patella  14  are then interfastened to their respective support straps  50 L or to the body  40  by adhering the patches of hook fastener material  54 L affixed on the distal ends  52 L of the support straps  50 L to the loop fastener material  56  distributed about the proximal outer surface of each support strap  50 L or the body  40 . Upon doing so, the buttress support member  60  is anchored in the desired position about the lateral outline of the patella  14  so as to provide appropriate directional supporting forces to ensure proper tracking of the patella  14  during both extension and flexion of the knee  10 . 
         [0030]    As shown in  FIGS. 1  ( a  &amp;  b ), and  4  ( a  &amp;  b ), the distal ends  52 M of the support straps  50 M oriented on the medial side of the knee  10  and patella  14  are then pulled in a medial direction until the desired tension across the support straps ( 50 L and  50 M) and the body  40  is achieved and such that the inner surface  42  of the body  40  and the guide pocket  62  remain in contact with the skin on the anterior side of the knee  10  and the patella  14 . While maintaining this desired tension, the distal ends  52 M of the support straps  50 M oriented on the medial side of the knee  10  and the patella  14  are then pulled around the outside of the upper arm  22 M and lower arm  24 M of the knee brace  20  and looped from the posterior side of the upper arm  22 M and lower arm  24 M of the knee brace  20  towards the anterior side of the medially disposed upper arm  22 M and lower arm  24 M of the knee brace  20  such that the loop fastener material  56  disposed about the surface of the support straps  50 M will adhere to the self adhering patches of loop fastener material  58  that have been disposed about the upper arm  22 M and lower arm  24 M of the knee brace  20 . The distal ends  52 M of the support straps  50 M oriented on the medial side of the knee  10  and the patella  14  are then interfastened to their respective support straps  50 M or the body  40 , achieved in one embodiment by adhering the patches of hook fastener material  54 M affixed on the distal ends  52 M of the support straps  50 M, depending on the amount of elastic deformation of the support straps  50 M caused by the tension force applied to the support straps  50 M, to the loop fastener material  56  distributed about the proximal exposed surface of each support strap  50 M, the body  40 , or, the exposed surface of the laterally disposed support straps  50 L. 
         [0031]    It is understood that the user may manipulate the level of directional support forces applied to the patella  14  by the tension strap  30  through the buttress support member  60  by increasing or decreasing the amount of tension applied when fastening the support straps ( 50 L and  50 M) in the manner described above. Thus, the amount of the directional forces applied to the patella  14  can be accurately adjusted for maximum efficiency and comfort of the wearer, and the tension strap  30  can be quickly applied without requiring any unusual skill. 
         [0032]    Upon attaching the tension strap  30  in this manner, one or more appropriate directional forces are applied to the patella  14  by means of tension forces applied to the buttress support member  60 . As shown in  FIG. 10 , one learned in the art will understand that a plurality of desirable directional forces can be supplied to the patella  14  by the buttress support member  60  by manipulating the locations at which the support straps ( 50 L and  50 M) are fastened about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the manner described above. 
         [0033]    A second embodiment of the invention is shown in  FIGS. 6  ( a  &amp;  b ),  7  ( a  &amp;  b ),  8  (a &amp; b) and  9  ( a  &amp;  b ) with the tension strap  30  having two primary parts: the body  40 , which engages the skin on the anterior side of the wearer&#39;s knee  10  and patella  14 ; and a plurality of support straps ( 50 L and  50 M) (here shown as four in number) extending distally from the body  40  which engage the knee brace  20  at the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) in the manner later described. As in the first embodiment of the invention, the body  40  is formed of a flexible, elastic material, such as, but not limited to neoprene with unbreakable looped backing (ULP) on the outer surface of the body  40 . The inner surface  42  of the body  40 , being that surface of the body  40  that will contact the skin on the anterior side of the wearer&#39;s knee  10  in the manner later described, is of a non-slip material, such as, but not limited to, exposed neoprene or synthetic shark skin. 
         [0034]    As in the first embodiment, the support straps ( 50 L and  50 M) are formed of a flexible, elastic material, such as, but not limited to, neoprene with unbreakable looped backing (ULP) on both sides of the support straps ( 50 L and  50 M). In one embodiment, the support straps ( 50 L and  50 M) and body  40  are affixed together by sewing, however, one skilled in the art will understand that the support straps ( 50 L and  50 M) and body  40  may be of unitary construction or may be affixed together by other like means. 
         [0035]    As shown in  FIGS. 4  ( a  &amp;  b ),  6  ( a  &amp;  b ),  7  ( a  &amp;  b ),  8  ( a  &amp;  b ) and  9  ( a  &amp;  b ), the lengths of the support straps ( 50 L and  50 M) are such to permit the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) to be wrapped or looped about the medially and laterally disposed upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the fashion later described. A patch of hook fastener material ( 54 L and  54 M) is affixed to the distal end ( 52 L and  52 M) of each support strap ( 50 L and  50 M). As shown in  FIGS. 7  ( a  &amp;  b ), in one embodiment, the outer dimensions of the patches of hook fastener material  54 L affixed to the distal ends  52 L of the support straps  50 L that are laterally oriented are contained within the outer dimensions of the outer surface of the support straps  50 L and may be affixed to the outer surface of the support straps  50 L by such means as gluing, sewing or through the use of double sided hook fastener material. In one embodiment, the patches of hook fastener material  54 M affixed to the distal ends  52 M of the medially oriented support straps  50 M append distally off the distal ends  52 M of the support straps  50 M and are affixed to the support straps  50 M by use of alligator tabs also of hook fastener material that adhere to both the inner and outer surface of the support straps  50 M. However, it will be appreciated that the patches of hook fastener material  50 M may be affixed to the distal ends  52 M of the support straps  50 M by any manner of acceptable means. 
         [0036]    As shown in  FIGS. 6  ( a  &amp;  b ),  8   b  and  9   b , because loop fastener material  56  is distributed about the proximal surfaces of each support strap ( 50 L and  50 M) and the outer surface of the body  40 , the support straps ( 50 L and  50 M) having been wrapped or looped about the medial and lateral upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the fashion later described, upon closing the looped support straps ( 50 L and  50 M), the patch of hook fastener material ( 54 L and  54 M) of each support strap ( 50 L and  50 M) will adhere to the loop fastener material  56  of each support strap ( 50 L and  50 M) or the outer surface of the body  40 , thereby securing the distal ends ( 50 L and  50 M) of the support straps ( 50 L and  50 M) about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0037]    As shown in  FIGS. 4  ( a  &amp;  b ),  6  ( a  &amp;  b ),  8  ( a  &amp;  b ) and  9  ( a  &amp;  b ), a self adhesive patch of hook fastener material ( 58 ) will also be applied to each of the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the desired positions along the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  where the support straps ( 50 L and  50 M) will be wrapped or looped about and secured to the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  so as to anchor the vertical positions of the support straps ( 50 L and  50 M) about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0038]    Operation of the tension strap  30  is described with continuing reference to  FIGS. 4  ( a  &amp;  b ),  6  ( a  &amp;  b ),  8  ( a  &amp;  b ) and  9  ( a  &amp;  b ). Prior to application of the tension strap  30 , the knee brace  20  is first fastened to the wearer&#39;s leg  12  in a normal fashion. As shown in  FIGS. 4   a ,  8  ( a  &amp;  b ) and  9   a , following the fastening of the knee brace  20  to the wearer&#39;s leg  12 , the body  40  of the tension strap  30  is placed over the anterior portion of the knee  10  with the inner surface  42  of the body  40  in contact with the skin on the anterior side of the wearer&#39;s knee  10  and patella  14 . The support straps ( 50 L and  50 M) are then inserted between the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  and the wearer&#39;s leg  12  and extended to the posterior side of the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . Self adhering patches of hook fastener material  58  are disposed about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  for vertically anchoring the support straps ( 50 L and  50 M) at the locations at which the distal ends ( 52 L and  52 M) of the support straps ( 50 L and  50 M) will be looped around the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20 . 
         [0039]    As shown in  FIGS. 6  ( a  &amp;  b ) and  9  ( a  &amp;  b ), the distal ends  52 L of the support straps  50 L oriented on the lateral side of the knee  10  and the patella  14  are then pulled around the outside of the laterally-oriented upper arm  22 L and lower arm  24 L of the knee brace  20  and looped from the posterior side of the laterally-oriented upper arm  22 L and lower arm  24 L of the knee brace  20  towards the anterior side of the laterally-oriented upper arm  22 L and lower arm  24 L of the knee brace  20  such that the loop fastener material  56  disposed about the surface of the support straps  50 L will adhere to the self adhering patches of hook fastener material  58  that have been disposed about the upper arm  22 L and lower arm  24 L of the knee brace  20 . The distal ends  52 L of the laterally-oriented support straps  50 L are then interfastened to their respective support straps  50 L or the body  40  by adhering the patches of hook fastener material  54 L affixed on the distal ends  52 L of the support straps  50 L to the loop fastener material  56  distributed about the proximal outer surface of each support strap  52 L or the body  40 . 
         [0040]    As shown in  FIGS. 4  ( a  &amp;  b ) and  6  ( a  &amp;  b ), the distal ends  52 M of the support straps  50 M oriented on the medial side of the knee  10  and patella  14  are then pulled in a medial direction until the desired tension across the support straps ( 50 L and  50 M) and the body  40  is achieved and such that the inner surface  42  of the body  40  is in contact with the skin on the anterior side of the knee  10  and the patella  14 . While maintaining this desired tension, the distal ends  52 M of the support straps  50 M oriented on the medial side of the knee  10  and the patella  14  are then pulled around the outside of the medially-oriented upper arm  22 M and lower arm  24 M of the knee brace  20  and looped from the posterior side of the medially-oriented upper arm  22 M and lower arm  24 M of the knee brace  20  towards the anterior side of the medially-oriented upper arm  22 M and lower arm  24 M of the knee brace  20  such that the loop fastener material  56  disposed about the surface of the support straps  50 M will adhere to the self adhering patches of hook fastener material  58  that have been disposed about the upper arm  22 M and lower  24 M of the knee brace  20 . The distal ends  52 M of the medially-oriented support straps  50 M are then interfastened to their respective support straps  50 M or the body  40 , achieved in one embodiment by adhering the patches of hook fastener material  54 M affixed on the distal ends  52 M of the medially-oriented support straps  50 M, depending upon the amount of elastic deformation of the support straps  50 M caused by the tension force applied to the support straps  50 M, to the loop fastener material  56  distributed about the proximal exposed surface of their respective support straps  50 M, the body  40 , or the exposed surface of the laterally disposed support straps  50 L. 
         [0041]    In both described embodiments of the present disclosure, through fastening the support straps ( 50 L and  50 M) of the tension strap  30  about the upper arms ( 22 L and  22 M) and lower arms ( 24 L and  24 M) of the knee brace  20  in the manner provided, each of the pair of polycentric hinge assemblies ( 26 L and  26 M) will be pulled inwardly towards each other about the joint of the knee  10  so as to provide resistance to vertical migration of the knee brace  20  about the wearer&#39;s knee  10 . Furthermore, because the non-slip inner surface  42  of the body  40  (and the guide pocket  62  in the first embodiment) will be in continuous engagement with the skin of the wearer of the knee brace  20 , further resistance to vertical migration of the knee brace  20  is provided during flexion and extension of the knee  10  while wearing the knee brace  20 . 
         [0042]    The construction of the tension strap  30  also reduces the need for large inventories in that only one size of tension strap  30  is required to fit the usual range of knee  10  and knee brace  20  dimensions. Further, while a knee brace  20  is typically constructed to fit either the right or the left leg  10 , but not both, the construction of the tension strap  30  is universal such that it can be used with a knee brace  20  designed to fit either the left or right leg  10 . 
         [0043]    It is appreciated that various modifications to the inventive concepts may be apparent to those skilled in the art without departing from the spirit and scope of the invention.