[ 0023 ] fig1 illustrates a preferred embodiment of the brace hinge with telescoping condyle pad . the hinge 20 is preferably a component of a knee brace ( not shown ) that is designed to treat osteoarthritis . those of skill in the art will appreciate , however , that the hinge 20 is adapted for use in a variety of braces , including prophylactic knee braces worn about healthy knees , and braces for parts of the body other than the knee . for simplicity , the construction and function of the hinge 20 will be described with reference to a knee brace . the illustrated hinge 20 is adapted for use on a lateral side of a right leg , or a medial side of a left leg . those of skill in the art will appreciate that a substantially identical hinge having a mirror image configuration would be adapted for use on a medial side of a right leg , or a lateral side of a left leg . for simplicity , the present hinge 20 will be described with reference to a lateral side of a right leg . the scope of the present hinge 20 is not , however , limited to an application to a lateral side of a right leg . the hinge 20 comprises a proximal arm 22 and a distal arm 24 pivotably engaging a hinge assembly . the hinge assembly comprises a lateral hinge plate 26 and a medial hinge plate 28 , as shown in the exploded view of fig2 . each of the hinge plates 26 , 28 is substantially oval in front elevation aspect ( fig3 ), and each includes a proximal aperture 30 and a distal aperture 32 ( fig2 ). the proximal aperture 30 is located substantially in the center of a proximal half of each hinge plate 26 , 28 , and the distal aperture 32 is located substantially in the center of a distal half of each hinge plate 26 , 28 . each of the hinge plates 26 , 28 also includes an anterior aperture 34 and a posterior aperture 36 . each anterior aperture 34 is located near a center of an anterior edge 38 of its respective plate , and each posterior aperture 36 is located near a center of a posterior edge 40 of its respective plate . those of skill in the art will appreciate that the apertures 34 , 36 need not be arranged in the fashion illustrated . both could for example , be located toward one side of the hinge plates , or be spaced from a proximal / distal axis of the hinge plates . the anterior and posterior apertures 34 , 36 include internal threads that cooperate with an anterior loading screw 44 and a posterior loading screw 46 , respectively , to adjust an amount of pressure exerted on a lateral side of the wearer &# 39 ; s knee , as explained below . the proximal arm 22 is a substantially flat plate having a hinge - engaging portion 48 at a distal end , and an upright - engaging portion 50 at a proximal end . the upright - engaging portion 50 is substantially rectangular , while the hinge - engaging portion 48 has a complex perimeter , including an anterior shoulder 52 , a posterior shoulder 54 , and a plurality of gear teeth 56 along proximal and posterior edges . the proximal arm 22 includes a pivot aperture 58 near the distal end . the distal arm 24 is substantially identical to the proximal arm 22 , but is a substantial mirror image of the proximal arm 22 about a line that passes through a center of the hinge 20 in an anterior / posterior direction . in a knee brace , the proximal arm 22 preferably engages a rigid proximal upright ( not shown ), and the distal arm 24 preferably engages a rigid distal upright ( not shown ). the proximal and distal uprights are secured to the wearer &# 39 ; s thigh and calf , respectively , with straps , cuffs or other suitable attachment devices . the uprights and their attachment devices thus anchor the brace to the wearer &# 39 ; s leg and enable the brace to provide the advantages outlined below . the proximal and distal arms 22 , 24 are sandwiched between the lateral and distal hinge plates 26 , 28 such that the pivot aperture 58 on the proximal arm 22 is coaxial with the proximal apertures 30 of the hinge plates 26 , 28 , and the pivot aperture on the distal arm 24 is coaxial with the distal apertures 32 of the hinge plates 26 , 28 . the arms 22 , 24 are preferably attached to the hinge plates 26 , 28 with rivets or other suitable attachment members that allow the arms to pivot with respect to the hinge plates 26 , 28 . in the embodiment of fig5 a pair of lateral rivets 60 pass through the proximal and distal apertures 30 , 32 of the lateral hinge plate 26 , through the pivot apertures of the proximal and distal arms 22 , 24 , and through the proximal and distal apertures 30 , 32 of the medial hinge plate 28 . those of skill in the art will appreciate that other attachment devices and methods could be used instead of the attachment configuration shown . an optional extension stop 62 ( fig2 ) is mounted to a lateral face 64 of the medial hinge plate 28 near a center of the anterior edge 38 . the anterior shoulder 52 of each arm 22 , 24 cooperates with the extension stop 62 to define a maximum extension angle for each arm 22 , 24 . an optional flexion stop ( not shown ) is securable to the medial hinge plate 28 near a center of the posterior edge 40 . the posterior shoulder 54 of each arm cooperates with the flexion stop to define a maximum flexion angle for each arm 22 , 24 . in the illustrated embodiment , the extension stop 62 includes proximal and distal apertures 66 , 68 that align with corresponding apertures 70 , 72 adjacent the anterior edge 38 of the medial hinge plate 28 . the extension stop 62 is secured to the medial hinge plate 28 with threaded fasteners , rivets , or other suitable attachment members that cooperate with the apertures 66 , 68 , 70 , 72 . the optional flexion stop , if one is provided , is secured to the medial hinge plate 28 in a similar fashion . those of skill in the art will appreciate that the stops could be secured to the hinge plates 26 , 28 in a variety of alternate ways , such as with an adhesive . those of skill in the art will further appreciate that neither the extension stop 62 nor the flexion stop is essential to achieving the advantages of the hinge 20 . as illustrated in fig2 an axis of rotation 74 of the proximal arm 22 is parallel to , but spaced from , an axis of rotation 76 of the distal arm 24 . such a bicentric hinge assembly more closely approximates the bending dynamics of the human knee , as is well understood in the art of orthopedic bracing . those of skill in the art will appreciate , however , that the features and advantages of the present hinge 20 may also be achieved with a monocentric hinge . preferably , a lateral spacer 78 separates the lateral hinge plate 26 from the arms 22 , 24 , and a medial spacer 80 separates the medial hinge plate 28 from the arms 22 , 24 . each of the spacers 78 , 80 is shaped substantially the same as the hinge plates 26 , 28 , including a substantially oval - shaped perimeter and proximal and distal apertures 82 , 84 . the spacers 78 , 80 are oriented such that their proximal and distal apertures 82 , 84 align with the proximal and distal apertures 30 , 32 , respectively , of the hinge plates 26 , 28 . the spacers 78 , 80 are preferably constructed of a material having a low coefficient of friction , such as a plastic . the spacers 78 , 80 thus enable the arms 22 , 24 to rotate more easily within the hinge assembly . those of skill in the art will appreciate that the spacers 78 , 80 could be shaped much differently , or could be eliminated entirely , without departing from the spirit of the hinge 20 . a lateral / medial force application assembly 86 telescopingly engages the hinge assembly on a medial side , as shown in fig4 and 7 a - 7 c . the assembly comprises a rigid loading plate 88 and a substantially rigid condyle shell 90 . for comfort , a resilient pad ( not shown ) may be attached to a medial surface of the shell 90 . either the shell 90 or the optional pad applies selective pressure to the lateral side of the wearer &# 39 ; s right knee in a manner described below . the loading plate 88 is substantially oval shaped and includes a proximal aperture 92 ( fig2 and 7a ) and a distal aperture 94 corresponding to the proximal and distal apertures 30 , 32 , respectively , of the hinge plates 26 , 28 . the condyle shell 90 is also substantially oval shaped and includes proximal and distal apertures 96 , 98 ( fig2 and 5 ) corresponding to the proximal and distal apertures 30 , 32 , respectively , of the loading plate 88 . a medial surface 100 of the loading plate 88 is secured to a lateral surface 102 of the condyle shell 90 , as shown in fig5 . in the illustrated embodiment , the loading plate 88 is secured to the condyle shell 90 via a pair of medial rivets 104 that cooperate with the proximal and distal apertures 92 , 94 , 96 , 98 on the loading plate 88 and condyle shell 90 . those of skill in the art will appreciate that the loading plate 88 and the condyle shell 90 could be secured to one another by other appropriate methods , such as by an adhesive . adjustment of the loading plate 88 and condyle shell 90 provides selective pressure on the wearer &# 39 ; s knee , as described below . thus , the loading plate 88 is preferably constructed of a rigid material such as a metal . in the illustrated embodiment , anterior and posterior edges 106 , 108 ( fig2 and 7a ) of the loading plate 88 are bent away from a plane of the plate 88 in a lateral direction . the bent edges 106 , 108 increase the bending strength of the plate 88 , enhancing the ability of the plate 88 to apply pressure to the wearer &# 39 ; s knee . those of skill in the art will appreciate that the bent edges 106 , 108 are not necessary to achieve the advantages of the hinge 20 . the loading plate 88 includes an anterior slot 110 ( fig2 and 7a ) running in an anterior / posterior direction . the anterior slot 110 is located near a center of the loading plate 88 as measured in a proximal / distal direction . the anterior slot 110 includes a wide portion at a posterior end 114 , and a narrow portion at an anterior end 116 . the loading plate 88 also includes a posterior slot 112 that is substantially identical to the anterior slot 110 , but is a mirror image of the anterior slot 110 about a line bisecting the loading plate 88 in a proximal / distal direction . the anterior slot 110 receives a medial end 118 of an anterior loading screw 44 , illustrated in fig6 and 7b . the posterior slot 112 receives a medial end 118 of a posterior loading screw 46 . the anterior and posterior loading screws 44 , 46 are substantially identical . as fig6 illustrates , the screws 44 , 46 include a threaded lateral portion 120 having a drive tool engagement feature , such as a female hex key 122 , on a lateral face 124 . the threaded portion 120 terminates near a medial end of the screw 44 , 46 in a first coaxial disk 126 having a diameter larger than that of the threaded portion 120 . a second coaxial disk 128 is attached to the first disk 126 via a coaxial cylindrical portion 130 having a diameter substantially the same as the threaded portion 120 . a space between the two disks 126 , 128 thus defines an annular gap 132 . the gap 132 on the anterior loading screw 44 engages the anterior slot 110 on the loading plate 88 , and the gap 132 on the posterior loading screw 46 engages the posterior slot 112 on the loading plate 88 , as shown in fig7 b . the disks 126 , 128 at the medial ends 118 of the screws 44 , 46 each have a smaller diameter than a width of the wide portions of the anterior and posterior slots 110 , 112 . however , the disks 126 , 128 each have a larger diameter than a width of the narrow portions of the anterior and posterior slots 110 , 112 . further , the cylindrical portions 130 of each screw 44 , 46 between the disks 126 , 128 have a smaller diameter than the width of the narrow portions of the anterior and posterior slots 110 , 112 . thus , the anterior loading screw 44 is insertable within the wide portion of the anterior slot 110 and slidable into the narrow portion of the anterior slot 110 such that the sides of the narrow portion of the anterior slot 110 are disposed between the disks 126 , 128 . the anterior slot 110 thus fixes the anterior loading screw 44 against translation in a direction perpendicular to the loading plate 88 . the slot sides are , however , somewhat thinner than the distance between the disks 126 , 128 , such that there is a small amount of “ play ” between the loading plate 88 and the screws 44 , 46 , as shown in fig7 b . the posterior loading screw 46 is engageable with the posterior slot 112 in the same manner that the anterior loading screw 44 is engageable with the anterior slot 110 . the threaded portion 120 of the anterior loading screw 44 engages the anterior holes 34 in the hinge plates 26 , 28 , as shown in fig7 c . the threaded portion 120 of the posterior loading screw 46 engages the posterior holes 36 in the hinge plates 26 , 28 . thus , the screws 44 , 46 are selectively positionable with respect to the hinge plates 26 , 28 in a direction perpendicular to the hinge plates 26 , 28 . because the screws 44 , 46 are fixed to the loading plate 88 , adjusting the position of the screws 44 , 46 within the apertures also adjusts the position and orientation of the loading plate 88 and condyle shell 90 with respect to the hinge plates 26 , 28 . [ 0041 ] fig7 a illustrates the loading screws 44 , 46 adjusted such that both screws 44 , 46 extend a minimum distance in the medial direction from the hinge plates 26 , 28 . in this configuration , the loading plate 88 and condyle shell 90 are substantially parallel to the hinge plates 26 , 28 and spaced only slightly from the hinge plates 26 , 28 . the condyle shell 90 ( or optional pad ) thus applies little or no pressure to the wearer &# 39 ; s knee , and any pressure is applied evenly across the knee in an anterior / posterior direction . [ 0042 ] fig7 b illustrates the loading screws 44 , 46 adjusted such that both screws 44 , 46 extend a maximum distance in the medial direction from the hinge plates 26 , 28 . in this configuration , the loading plate 88 and condyle shell 90 are substantially parallel to the hinge plates 26 , 28 and spaced greatly from the hinge plates 26 , 28 . the condyle shell 90 ( or optional pad ) thus applies maximum pressure to the wearer &# 39 ; s knee , and the pressure is applied evenly across the knee in an anterior / posterior direction . [ 0043 ] fig7 c illustrates the loading screws 44 , 46 adjusted such that the posterior loading screw 46 extends from the hinge plates 26 , 28 in the medial direction a greater amount than the anterior loading screw 44 . in this configuration , the loading plate 88 and condyle shell 90 are oriented at an angle relative to the hinge plates 26 , 28 . the condyle shell 90 ( or optional pad ) thus applies greater pressure to a posterior portion of the wearer &# 39 ; s knee than to an anterior portion of the wearer &# 39 ; s knee . although not depicted , the lateral / medial force application assembly 86 is also configurable in a manner opposite from that of fig7 c . in this configuration the anterior loading screw 44 extends from the hinge plates 26 , 28 in the medial direction a greater amount than the posterior loading screw 46 . the condyle shell 90 ( or optional pad ) thus applies greater pressure to an anterior portion of the wearer &# 39 ; s knee than to a posterior portion of the wearer &# 39 ; s knee . the ability of a brace including the present hinge 20 to apply differing pressures to anterior and posterior portions of a wearer &# 39 ; s knee enables such a brace to be adapted to a wide variety of treatment situations . every human knee is unique , and there are a wide variety of knee injuries and knee injury prevention situations . in certain situations it is advantageous for a patient to have greater pressure applied to an anterior portion of his or her knee , and in certain other situations it is advantageous for a patient to have greater pressure applied to a posterior portion of his or her knee . current braces do not allow for such adjustable application of pressure to anterior and posterior portions of a patient &# 39 ; s knee as does a brace including the present hinge 20 . further , the configuration of the present hinge 20 spread loads over a greater area of the hinge plates 26 , 28 than other current designs . for example , in the hinge of u . s . pat . no . 5 , 807 , 294 , described above , the adjustment members 74 , 88 pass through the hinge fasteners 68 , 82 . thus , all loads applied to the lateral pad 26 are transmitted to the hinge fasteners , and all loads applied to the arms 34 , 46 are also transmitted to the hinge fasteners . the hinge fasteners in turn transmit these loads to the areas of the hinge plates 58 , 60 in which they are disposed . this configuration concentrates tremendous loads on two small areas of the hinge plates 58 , 60 . these loads lead to rapid wear of the hinge plates 58 , 60 and eventually failure . in the configuration of the present hinge 20 , however , loads applied to the condyle shell 90 are transmitted through the loading screws 44 , 46 to the anterior and posterior aperture 34 , 36 of the hinge plates 26 , 28 . loads applied to the arms 22 , 24 are transmitted through the lateral rivets 60 to the proximal and distal aperture 30 , 32 of the hinge plates 26 , 28 . the loads are thus spread over a greater area of the hinge plates 26 , 28 . the hinge plates 26 , 28 are thus able to withstand more prolonged use without failure . alternatively , the hinge plates 26 , 28 are able to be made using less material , which results in lighter hinge plates and an overall lighter brace . the above presents a description of the best mode contemplated for the present brace hinge with telescoping condyle pad , and of the manner and process of making and using it , in such full , clear , concise , and exact terms as to enable any person skilled in the art to which it pertains to make and use this brace hinge with telescoping condyle pad . this brace hinge with telescoping condyle pad is , however , susceptible to modifications and alternate constructions from that discussed above which are fully equivalent . consequently , it is not the intention to limit this brace hinge with telescoping condyle pad to the particular embodiments disclosed . on the contrary , the intention is to cover all modifications and alternate constructions coming within the spirit and scope of the brace hinge with telescoping condyle pad as generally expressed by the following claims , which particularly point out and distinctly claim the subject matter of the brace hinge with telescoping condyle pad .
a brace hinge is provided having an adjustable pressure - applying assembly mounted to an inside of the hinge . a brace including the hinge can apply pressure to a joint in a medial or lateral direction . the hinge includes anterior and posterior apertures containing anterior and posterior adjustment members that control a position and orientation of the pressure - applying assembly relative to the hinge . through selective adjustment of the adjustment members , the hinge can apply greater pressure to an anterior portion of the joint than to a posterior portion of the joint , and vice versa . a method of treating a joint using a brace including such a hinge is also provided .