Name of the Procedure:

Knee Orthosis (KO), Double Upright, Thigh and Calf with Adjustable Flexion and Extension Joint (Unicentric or Polycentric), Medial-Lateral and Rotation Control, with or without Varus/Valgus Adjustment, Prefabricated, Off-the-Shelf (HCPCS Code: L1852)

Summary

A Knee Orthosis (KO) is a medical device designed to support the knee. It includes uprights extending along both sides of the knee, connecting to supports on the thigh and calf. This type of orthosis allows for adjustable movement in flexion and extension, controls side-to-side (medial-lateral) and rotational movement, and may have varus/valgus adjustment to correct knee alignment.

Purpose

The Knee Orthosis (KO) aims to:

• Provide joint stability
• Assist in proper knee alignment
• Reduce knee pain
• Aid in rehabilitation following knee injury or surgery
• Prevent further knee damage

Indications

This orthosis is appropriate for patients who have:

• Knee instability due to ligament injuries (e.g., ACL, MCL, PCL injuries)
• Degenerative knee conditions such as osteoarthritis
• Post-operative conditions needing controlled motion and support
• Conditions requiring medial-lateral and rotational support

Preparation

Generally, no specific preparation is needed for fitting the orthosis. However, a medical assessment will be conducted to determine the appropriate size and type of orthosis required. Patients should wear comfortable clothing that allows easy access to the knee for accurate fitting.

Procedure Description

1. Assessment: The healthcare provider evaluates the knee condition.
2. Selection: A suitable off-the-shelf KO is selected based on the patient’s requirements.
3. Fitting: The KO is placed around the knee, and the uprights are aligned along the medial and lateral sides of the knee.
4. Adjustment: Flexion and extension hinges, as well as varus/valgus alignment, are adjusted for optimal support.
5. Education: The patient is instructed on how to wear, remove, and care for the orthosis.

Duration

Fitting the orthosis typically takes 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient clinic or an orthopedic specialist’s office.

Personnel

A certified orthotist or a trained healthcare professional will carry out the fitting and adjustment of the orthosis.

Risks and Complications

• Common Risks: Skin irritation or pressure sores from improper fit.
• Rare Risks: Allergic reactions to the materials used.
• Management: Regular follow-up appointments ensure proper fit and adjust for any discomfort.

Benefits

Patients can expect:

• Immediate stabilization of the knee
• Pain relief
• Improved joint function and mobility
• Enhanced confidence in performing daily activities

Recovery

Recovery involves:

• Wearing the KO as directed (e.g., during activities or all day)
• Gradual increase in activity level as knee stability improves
• Regular follow-ups to adjust the orthosis

Alternatives

• Custom-made orthosis: Provides a more personalized fit but at a higher cost.
• Physical Therapy: Focuses on strengthening muscles to support the knee.
• Surgery: Considered for severe cases or when conservative treatments fail.
  • Pros: Long-term solution.
  • Cons: Invasive, long recovery period.

Patient Experience

During the fitting:

• The patient may feel some discomfort as adjustments are made. After the fitting:
• The patient might feel restrictive initially but will adapt as they get used to wearing the orthosis.
• Pain management includes proper padding and regular skin checks to prevent sores.

Patients are encouraged to communicate openly with their healthcare provider about any discomfort or concerns to ensure optimal use of the knee orthosis.