JP7728593B2 - Apparatus and method for stabilizing a human joint - Google Patents

Description

The present invention relates to the medical field exemplified by IPC A61, and in particular to human joint stabilization devices, such as walking aids, and related methods. In one aspect, the present invention relates to a device for stabilizing a human knee and the operation of the device configured and arranged to treat damaged ligaments in the knee.

Orthopedic braces are used to stabilize the joints of the human limbs when there is an injury to the joint or the limb that connects around the joint. Braces are used to stabilize the knee, ankle, elbow, and wrist. The application of a brace minimizes the risk of further damage by reducing the strain on the injured limb or joint while allowing the limb or joint to function.

Several knee brace products have been developed to specifically protect knee ligaments, such as the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL). These ligaments are often injured when individuals overuse their knees, especially those involved in avid sports activities. The lateral collateral ligament (LCL) is also sometimes strained. Brace products that protect these ligaments vary greatly in terms of technology, function, and efficacy. Such products are disclosed in International Patent Publication Nos. WO/2019/113700 and WO/2020/093160, both of which are assigned to the assignee of the present application.

Some products focus on mechanically encasing the joint while maintaining joint articulation. These products have somewhat heavy hinge mechanisms, are generally bulky, and are not particularly aesthetically pleasing. At the other extreme, there are several products in the form of garments, which are different forms of garments using different technologies to apply compression near the knee while stabilizing the knee and protecting the ligaments mentioned above. Some garments have the disadvantage of not applying sufficient compression. Others apply sufficient compression overall, but do not apply that compression directly to key anatomical areas.

Knee brace products, developed to address osteoarthritis, focus on unloading pressure on the medial compartment cartilage. Unloader knee braces come in two main styles: condylar pad and force strap. Condylar pad designs use a three-point bending mechanism centered on pressure applied to the condylar pad to reduce the moment acting on the knee. Force strap designs apply the moment using straps that encircle the knee. In both cases, pressure from the condylar pad or straps can cause discomfort and restrict blood circulation. Braces designed to unload pressure on the medial compartment have also been known to put pressure on the peroneal nerve, resulting in numbness or pain. Studies have shown that more than half of patients discontinue use of these braces due to these issues. Unloader knee braces also suffer from many of the same issues as traditional braces, including mobility, comfort, size, and weight, leading to poor fit.

There is a need for an unloader knee brace that does not impede blood circulation in the popliteal artery with a valgus moment. There is also a need to avoid pain and discomfort with prolonged use. Furthermore, there is a need for a brace that does not exert condylar forces on the lateral condyle. There is a need for an unloader brace to address the additional issues listed and reduce dissatisfaction with these devices.

A first aspect is directed to a garment arranged to at least partially encase a joint of the human body, the garment having one or more tension members each longitudinally arranged along a corresponding predetermined curved three-dimensional spatial path within or on a matrix of garment material, the corresponding predetermined path spatially relating the one or more tension members to at least one natural ligament of the joint. The one or more tension members may each include one or more strands of a substantially longitudinally inextensible material. The garment material may include conduits arranged within or on the garment material to receive one or more strands of each tension member. Each conduit may have a lower coefficient of friction with respect to the strands than the coefficient of friction of the garment material with respect to the strands. Each conduit includes one or more tubes of a material different from the garment material, the tubes longitudinally arranged along the predetermined three-dimensional spatial path of the corresponding tension member.

The garment may further include at least one tensioner disposed along at least one of the one or more tensioning members for tensioning the at least one tensioning member. At least one of the one or more tensioning members may further include at least one tension adjuster disposed to balance differences in tension between different strands of the at least one tensioning member.

The joint may be a knee with a patella in a human leg, and the locus of at least one of the one or more tension members may include a lateral segment positioned perpendicularly adjacent to and extending laterally from the patella and a medial segment positioned perpendicularly adjacent to and extending medially from the patella. The garment may include at least one portion of non-stretchable fabric around the rear of the foot, connecting the medial segment of at least one tension member to the lateral segment of at least one tension member.

The outer and inner segments of the at least one tension member may further be positioned to cross each other above and below the knee at upper and lower intersection points, respectively. The garment may further include a portion of non-stretch fabric connecting the inner segment of the at least one tension member to the lateral segment of the at least one tension member that covers the front of the above-knee area at the upper intersection point, and a portion of non-stretch fabric connecting the inner segment of the at least one tension member to the lateral segment of the at least one tension member that covers the front of the below-knee area at the lower intersection point.

Generally, when the articulation joint is the knee, the garment may include a section of non-stretch fabric joining two segments of a tension member laterally, which are tensioned horizontally against each other on the leg.

The garment may further include a belt arranged to tighten the garment about the waist of the human body and a stabilizing connector connecting at least one tension member to the belt, the stabilizing connector being constructed from a substantially non-stretchable material.

The three-dimensional spatial locus of the at least one tension member may extend around the articulated foot. The three-dimensional spatial locus of the at least one tension member may be positioned such that tension within the at least one tension member creates or exerts a compressive force near the joint. At least one longitudinal portion of the one or more tension members may be comprised of a section of substantially inextensible fabric.

In another aspect, the garment includes a closed tension loop configured to move freely along a conduit within or on the garment, the conduit positioned to cross over itself between the lateral and medial sides of the front of the user's foot, at least either above or below the knee. In one embodiment, the conduit is positioned to cross over itself between the lateral and medial sides of the front of the user's foot, both above and below the knee. The tension loop is positioned within or on the garment to apply pressure to at least one of the user's lateral collateral ligament and medial collateral ligament when the garment is worn on a user and the tension loop is pulled. The garment may further include a tensioner configured to apply tension to the tension loop. The garment may further include a belt positioned to fit around the user's waist, the tension loop being anchored to the belt. The conduit may be positioned along a path around the foot in the vicinity of the triceps surae muscle.

The garment may include an anchor member, and the tension member and anchor member may be joined in a manner that at least partially or substantially encircles the thigh. In other embodiments, the tension member at least partially or substantially encircles the thigh.

The tension loop may have a tension member extending along a conduit sandwiched between layers of low-friction material. The garment may be formed from garment material, and the conduit may be contained within the garment material and laterally bounded by stitches. The stitches may be constructed from low-friction fabric. The tension loop may have a tension member extending along the conduit, and the conduit may be constructed from low-friction tubing. Alternatively, the conduit may be constructed from low-friction butted tubing. The tension loop may have a tension member made from a substantially longitudinally inextensible material, which may be flexible.

In another aspect, a method for stabilizing the knee of a human user's leg includes applying a wearable garment around the user's knee, the garment having a garment foot, a garment knee, a tensioner, and a closed tensioning loop disposed freely movable longitudinally along a conduit within or on the garment and disposed around the garment foot, the conduit being positioned to cross itself between the medial and lateral sides of the front of the garment leg above and below the knee of the garment, the tensioner being positioned to adjust the tension of the loop, and actuating the tensioner to adjust the tension of the loop.

The application may be configured to have the user place the garment by placing a first portion of the loop against the end region of the triceps surae muscle of the user's foot, placing a second portion of the loop on or above the thigh of the user's foot, and positioning the third and fourth portions of the loop between the first and second portions on the medial and lateral sides of the patella of the user's foot, adjacent to two collateral ligaments of the user's knee. The positioning of the second portion of the loop may include placing the second portion of the loop against the back of the thigh of the user's foot.

In another aspect, a method of manufacturing a wearable garment for stabilizing a user's knee includes forming a garment that covers at least a portion of the knee, the proximal triceps surae muscle, and the distal portion of the proximal thigh; providing a conduit within or on the garment to receive a tension loop, the conduit positioned to cross itself between the medial and lateral sides of the front of the garment, at least above or below the knee of the garment; routing a tension member along a path through the conduit; and providing a tensioner within or on the loop for adjusting the tension of the loop.

Threading the tension member may comprise threading a substantially inextensible tension member. Threading the tension member may comprise threading a flexible, substantially inextensible tension member. Threading the tension member may comprise threading a tension member made from one or more of PTFE, stainless steel, Nylon (registered trademark), Kevlar (registered trademark), ultra-high molecular weight polyethylene-based fibers, and diamond weave fibers. Threading a tension member made from diamond weave fibers may comprise threading a tension member made from any of cotton, polyester, polypropylene, and Technora (registered trademark).

Providing the conduit may include positioning the conduit so that it crosses itself above and below the knee. Shaping the garment may include extending the garment to the waist of the user and forming a belt around the waist. Providing the tensioner may include positioning the tensioner in the belt. Providing a tensioner on or in a loop may include positioning the tensioner on the thigh of the garment.

In a further embodiment, a wearable garment for stabilizing a user's knee includes a closed tension loop disposed for free movement along a conduit disposed in or on the garment, the conduit extending along a conduit path having a lateral portion and a medial portion relative to the knee, the conduit having an adjustable tensioner disposed in or on the loop for adjusting tension within the loop, the lateral and medial portions of the conduit path passing through the patella of the user's knee adjacent the lateral and medial collateral ligaments of the user's knee, respectively, and the lateral and medial portions of the conduit path being adjacent to each other at at least one point below and one point above the user's knee.

The lateral and medial portions of the conduit path may be adjacent to one another at a first point below the user's knee and a second point above the user's knee. The tension loop may be positioned such that, when the garment is worn by a user and the tension loop is pulled, pressure is applied to at least one of the user's lateral collateral ligament and medial collateral ligament. The conduit may be positioned along a path that substantially circumferentially circumferentially the foot at the end region of the triceps surae muscle. The tension loop may have a tensioning member extending along the conduit. The tensioner may be positioned on the user's thigh. The tensioning member may be made of a material that is substantially inextensible in the longitudinal direction, and the material may be flexible. The conduit may be comprised of low-friction tubes arranged in series.

In another aspect, a method of manufacturing a wearable garment for stabilizing a user's knee includes the steps of: molding a garment that at least partially covers the knee, the adjacent triceps surae muscle, and a distal portion of the adjacent thigh; providing a conduit within and/or on the garment for receiving a tension loop, the conduit extending along a conduit path having lateral and medial portions relative to the knee, the lateral and medial portions of the conduit path approaching each other at least at one point, the at least one point being at least one of above and below the user's knee; threading a tension member within the conduit along the path; and providing a tensioner within and/or on the loop for adjusting tension in the loop.

The step of passing a tension member may include passing a substantially inextensible tension member. The step of passing a tension member may include passing a flexible, substantially inextensible tension member. The step of passing a tension member may include passing a tension member made from one or more of PTFE, stainless steel, Nylon (registered trademark), Kevlar (registered trademark), ultra-high molecular weight polyethylene-based fibers, and diamond weave fibers.

Passing a tension member made from diamond weave fibers may include passing a tension member made from any of cotton, polyester, polypropylene, and Technora®. Providing a conduit may include positioning the conduit so that outer and inner portions of the conduit path are adjacent to each other above and below the user's knee. Shaping the garment may include extending the garment to the user's waist, forming a belt around the waist, and positioning a tensioner on the belt. Positioning a tensioner in or on the loop may include positioning a tensioner on the thigh of the garment.

In a further embodiment, a wearable brace garment for stabilizing a wearer's joint is presented. The garment is positioned to at least partially encase the joint. The garment includes a tension member disposed on the garment or in a conduit within the garment in a spatial pathway around the joint. The tension member includes a woven fabric having a plurality of substantially inextensible strands along its length and laterally extending strands, each of which is disposed in a corresponding strand conduit. The garment also includes a tensioner disposed on the garment to adjust the tension within the tension member, and a tension equalizer disposed on the garment in tensile communication with the tensioner and the strands of the tension member, the tension equalizer equalizing tension among the plurality of inextensible strands of the tension member. The tension equalizer may be a Whipple tree, including a multi-layer Whipple tree. The Whipple tree may more specifically be a two-layer or three-layer Whipple tree.

The Whipple tree may use pulleys and/or threadable members. The threadable members may include beads, rings, grommets, blocks, loops of non-stretchable fabric, loops of non-stretchable cable, and Whipple bars for engaging with the non-stretchable strands of the tension member. The pulleys, threadable beads, rings, grommets, blocks, and Whipple bars may be formed from any material capable of withstanding the applied tension, including wood, metal, plastic, and other suitable polymeric materials. Polymeric elements may be formed by injection molding or three-dimensional printing techniques.

The garment may be made of a garment material, and each conduit may have a lower coefficient of friction with the strands than the coefficient of friction of the garment material with respect to the strands. Each of the conduits may comprise a tube of a material different from the garment material. The three-dimensional spatial path of the tension member may be arranged such that tension in the tension member creates a compressive force adjacent the joint. A tensioner may be engaged with the tensioner to provide a mechanical advantage in applying tension to the tensioner. The joint may be one of the wearer's ankle, elbow, wrist, shoulder, hip, neck, spine, and one or more vertebrae.

The above and other features, objects, and methods for achieving these of the present invention will become clearer and the invention itself can be better understood by referring to the following examples of the invention and the accompanying drawings.

1 illustrates the general anatomy of the left human knee, with the kneecap and its attachments removed for clarity.

1A and 1B are diagrams showing a first embodiment of a brace garment (corrective garment) for reinforcing a human left knee.

10A and 10B are diagrams showing another embodiment of a brace garment (corrective garment) for reinforcing a human left knee.

10A and 10B are diagrams showing another embodiment of a brace garment (corrective garment) for reinforcing a human left knee.

FIG. 3 is an enlarged detail view of the thigh portion of FIG. 2;

FIG. 1 illustrates the configuration of a tension member and conduit in one embodiment.

10A and 10B show the configuration of tension members and conduits in other embodiments.

10A and 10B show the configuration of tension members and conduits in other embodiments.

1 is a flowchart illustrating a method for stabilizing the knee of a human leg.

1 is a flow chart showing a method for manufacturing a brace garment for reinforcing a human knee.

10A-10C show another embodiment of a brace garment for reinforcing the left knee of a human.

10 is a flow chart illustrating another method for manufacturing a brace garment for reinforcing a human knee.

10A-10C show another embodiment of a brace garment for reinforcing the left knee of a human.

6C shows an embodiment of a tension adjustment device having the tension member of FIG. 6B.

12A-12C show an embodiment of a tension adjustment device for use in adjusting the tension at the two ends of the tension member of FIG. 11.

FIG. 1 is a perspective view of a brace garment with a tensioner and tensioner. FIG. 1 is a perspective view of a brace garment with a tensioner and tensioner.

14A and 14B, showing how the multiple strands of the composite inextensible cable are guided by conduits within the calf grip of the garment.

14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the two-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG.

14C are schematic diagrams showing different embodiments of the three-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the three-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG. 14C are schematic diagrams showing different embodiments of the three-layer Whipple tree tensioner of the garment of FIGS. 14A and 14B. FIG.

FIG. 1 is a perspective view of one embodiment of a brace garment for supporting a wearer's shoulder joint. FIG. 1 is a perspective view of one embodiment of a brace garment for supporting a wearer's shoulder joint.

FIG. 10 is a perspective view showing another embodiment of a brace garment for supporting the shoulder joint of a wearer. FIG. 10 is a perspective view showing another embodiment of a brace garment for supporting the shoulder joint of a wearer.

1 illustrates an embodiment of a brace garment that supports the ankle joint of a wearer.

1 illustrates an embodiment of a brace garment that supports a wearer's wrist joint. 1 illustrates an embodiment of a brace garment that supports a wearer's wrist joint.

1 illustrates an embodiment of a brace garment for supporting a wearer's elbow joint. 1 illustrates an embodiment of a brace garment for supporting a wearer's elbow joint. 1 illustrates an embodiment of a brace garment for supporting a wearer's elbow joint.

Corresponding reference characters indicate corresponding parts throughout the drawings. Although the drawings depict embodiments of the present invention, the drawings are not necessarily drawn to scale and certain features may be exaggerated to more fully illustrate and explain the present invention. The flowcharts and screenshots are representational in nature, and an actual embodiment of the present invention may include additional features or steps not shown in the drawings. The examples described herein illustrate embodiments of the present invention in one form and should not be construed as limiting the scope of the present invention in any way.

The embodiments disclosed below are not intended to be exhaustive or to limit the invention to the precise forms disclosed in the following detailed description. Rather, the embodiments are chosen and described so that others skilled in the art may utilize these teachings.

The present invention relates to a garment having a brace arrangement for an articulating joint of the human body. The brace has tension members on or within a matrix of garment material, each longitudinally arranged along a corresponding predefined curved three-dimensional spatial locus, which spatially associates one or more tension members with at least one natural ligament of the joint. To explain the garment and brace, first consider the human knee shown in Figure 1.

FIG. 1 shows the internal knee joint 100 of a human left knee from an anterior view, with the patella, or kneecap, and its attachment removed to reveal the internal anatomy of this particular joint. The major bones of the leg shown are the femur 110, tibia 120, and fibula 130. Where these bones meet during joint articulation, there is symphysis cartilage 140, and the two cartilaginous portions on the tibia 120 are the medial meniscus 144 and lateral meniscus 146. The bones are stabilized relative to one another by strategically placed ligaments that hold the bones together. These bones include the posterior cruciate ligament (PCL) 150 and anterior cruciate ligament (ACL) 160, which connect the surfaces of the femur 110 and tibia 120 together while interacting with each other, and the medial collateral ligament (MCL) 170 and lateral collateral ligament (LCL) 180, which connect the medial and lateral sides of the head of the femur 110 to the tibia 120 and fibula 130, respectively.

In the following description, the exemplary garments of the present invention are shown as being positioned from the mid-section of a person's body down the legs, spanning the entire lower part of the body, including the feet, which are covered by the garment. However, actual embodiments may or may not extend all the way down to or beyond the waist, and may or may not fully cover the feet. The configuration of these garments according to the present invention may depend on the style, manufacturing method, and/or the particular configuration of each individual situation. Therefore, the detailed descriptions of the exemplary embodiments that follow are intended to represent only a few of the possible variations in the garments.

The brace garment shown in FIG. 2 is a first embodiment. The garment 200 is worn on the knee joint shown in FIG. 1 and includes a belt 210, a tensioning member 220, a fixing member 230, and a tensioner 240. The dashed rectangle 100 represents the area of the left leg shown in FIG. 1. The tensioning member 220 follows a predetermined path related to the location of the ligaments 150, 160, 170, and 180 described above. The tensioning member 220 travels from the tensioner 240 at point A to point B, where the tensioning member 220 branches off from its path, forming a closed loop. The path travels from the left side, passes through the left patella 190 on the medial side, turns again, and reaches the lateral side of the left foot at point C, the distal end of the triceps surae (a muscle group in the human calf). From there, it again circles the dorsal surface of the foot (shown by a dotted line) and reaches point D on the medial side of the left foot. From point D, it travels along a curved path that circles the side of the patella 190, intersecting itself at point E. After intersecting itself at point F, the path reaches point B, where it makes a sharp left-lateral turn and rejoins. At intersections E and F, the two extensions of tension member 220 are independent of each other and are not joined, allowing them to move freely relative to each other as much as possible.

The path of the securing member 230 extends from point G on the tensioner 240, around the back of the thigh (shown in dotted lines) via point H on the medial side, to point I, where it terminates at the proximal tensioning member 220. The path of the tensioning member 220 makes a sharp bend at point I. The precise manner in which the securing member 230 and the tensioning member 220 are disposed at point I will be described in detail below. For present purposes, it is sufficient to note that the path of the securing member 230 and the path of the tensioning member 220 cooperate to create a closed loop that circumscribes the thigh to secure the brace garment 200 to the thigh. That is, with reference to further examples below, the tensioning member 220 and the securing member 230 together fully encircle the thigh, regardless of any securement features disposed between the tensioning member 220 and the securing member 230. The loop from point C to point D to point E formed by the path of the tension member 220 in the calf of the leg similarly secures the brace garment 200 to the calf.

In use, the tensioning member 220 may be configured to have its tension adjusted by the wearer of the garment 200 via the tensioner 240. Similarly, in some embodiments, the securing member 230 extends along a path within the conduit, as described in more detail below, and the tensioning member 230 may be configured to have its tension adjusted by the tensioner 240. In other embodiments, the securing member 230 may be constructed from a longitudinally non-stretchable material, and the tensioner 240 may be disposed on the non-stretchable material such that tensioning the tensioning member 220 also tensions the securing member 230.

The tensioner 240 can take a variety of forms, including those without a backstop or connector. Any configuration that can apply longitudinal tension to the tension member 220 and is compatible with human movement is suitable.

The embodiment of FIG. 2 specifically shows tension member 220 crossing itself both above and below the knee. In more general embodiments, tension member 220 may only cross itself above or below the knee. However, it may be advantageous for the upward and downward portions of the path of tension member 220 to be adjacent to each other on opposite sides of the knee, where tension member 220 actually crosses itself.

A second embodiment of a garment according to the present invention is shown in FIG. 3 as garment 200', comprising belt 210', tension member 220', and tensioner 240'. In this embodiment, the schematic path of tension member 220' starts at point A' on tensioner 240' of belt 210' on the right hip. From point A', it travels around the wearer's back (shown in dashed lines) to point B' located on the lateral side of the left foot. At this point, tension member 220' diverges, forming a single closed loop. The loop then travels from the left side to the medial side of the left foot, passing over patella 190, before bending again to reach point C' on the lateral side of the left foot at the distal end of the triceps muscle. From there, it travels around the dorsum of the foot (shown in dashed lines) again to reach point D' on the medial side of the left foot. From point D', it follows a curved path that circles around the side of the patella 190 before intersecting itself at point E' and then again at point F'. The path then makes a sharp turn to the left side to point B' where it rejoins itself. At intersections E' and F', the outgoing and incoming sections of tension member 220' are independent and not connected to each other, allowing them to move freely relative to each other as much as possible.

In this embodiment, the tensioning member 220' not only creates or exerts a stabilizing compressive force on the knee region 100 because it encircles the foot, but also creates or exerts a force on the foot and garment such that the tensioning member 220' secures the foot in the region C'-E'-F' around the calf. Thus, the tensioning member 220' acts as a distal anchor for the foot and is secured at the distal end of the belt 210' by the fact that the tensioning member 220' completes at least a portion, and perhaps most, of a circle around the body. In practice, the tensioning member 220' may be adjusted in tension by the wearer of the garment 200' via the tensioner 240'. In other embodiments, the tensioner may be positioned to extend further around the front of the torso, such that the tensioning member 220' completely encircles the thigh when viewed from above. The phrase "fully encircling the thigh" is intended to encompass this condition, even if the actual path is helical in nature. The portion of tension member 220' extending from point A' to point B' in Figure 3 can also be viewed as a fixing member, which serves the same purpose as fixing member 230 in the embodiment of Figure 2.

The embodiment of FIG. 3 specifically shows tension member 220' crossing itself both above and below the knee. In more general embodiments, the tension member need only cross itself either above or below the knee. However, it may be advantageous for the upward and downward portions of the path of tension member 220' to be adjacent to each other on opposite sides of the knee, where tension member 220' actually crosses itself.

A further example of a garment is shown in Figure 4 as garment 200'', which comprises belt 210'', tension member 220'', and tensioner 240''. In this example, the schematic path of tension member 220'' starts at point A'' on tensioner 240''. From point A'', the path passes along the medial side of the left patella 190, turns again to meet the lateral side of the left foot at point C'', at the distal end of the triceps muscle, then travels around the dorsum of the foot to meet the medial side of the left foot at point D'' (shown in dashed line). From point D'', the path continues, intersecting with itself at point E'', then travels along a path that wraps around the lateral side of the patella 190, before reuniting with itself at point F''. The path follows around the inside of the thigh at point G'', then around the back of the thigh (shown in dashed lines) and reaches tensioner 240'' at point H''. At intersections E'' and F'', the outgoing and incoming sections of tension member 220'' are not connected to each other, allowing them to move freely relative to each other as much as possible.

In this manner, tensioning member 220'' not only creates or exerts a stabilizing compressive force on knee region 100 by encircling the foot, but also creates or exerts a force on the foot and garment such that tensioning member 220'' secures the foot in region C''-E''-F'' around the calf. Tensioning member 220'' thus functions as a distal fixation member for the foot. Similarly, by encircling the foot around the thigh, tensioning member secures the garment to the thigh. In practice, tensioning member 220'' may be adapted to have its tension adjusted by the wearer of garment 200'' via tensioner 240''.

The embodiment of FIG. 4 specifically shows tension member 220'' crossing itself both above and below the knee. In more general embodiments, the tension member need only cross itself either above or below the knee. However, it may be advantageous for the upward and downward portions of the path of tension member 220'' to be adjacent to each other on opposite sides of the knee, where tension member 220'' actually crosses itself.

In the embodiments of Figures 2, 3, and 4, tensioning members 220, 220', 220" are described in each case as stretchable loops, even though the stretchable loops are not circular and even though tensioners 240, 240', 240" (if present) are within the loops. Furthermore, in various embodiments, tensioning members 220, 220', 220" and anchoring member 230, individually or in combination, may completely, primarily, or at least partially encircle the thigh.

In the embodiment shown in Figures 2 and 4, the garment need not be in the form of a complete lower body garment, but need only cover the relevant portion of the leg to be stabilized. In the fastening arrangement of Figures 2 and 4, the belts 210', 210" are eliminated. Therefore, the embodiment shown in Figures 2 and 4 can also be used in the form of tights for the relevant leg, extending from above the thigh to below the calf. The wearer may wish to use a larger garment for aesthetic reasons. In the general context of a complete lower body garment, the self-fastening of the tension members 220, 220" does not require the garment to extend down to or cover the foot. The garment 200, 200', 200" may encase the knee in whole or in part. For example, the posterior portion of the knee or patella may essentially remain uncovered by the garment 200, 200', or 200".

The exact path of tension members 220, 220', 220" is determined by the force required to stabilize the knee, which in turn is determined by the support and compression required of the four ligaments of the knee as described in FIG. 1. In this regard, it should be noted that tension members 220, 220', 220" pass adjacent to the two lateral ligaments MCL and LCL, exerting pressure on the knee in these areas. Thus, the path of tension members 220, 220', 220" is predetermined by the location of the ligaments. In FIGS. 2, 3, and 4, a single tension member is shown positioned longitudinally along a predetermined path. That is, tension is directed longitudinally along the path. The garment may generally have one or two tension members, each longitudinally disposed along a corresponding predetermined curved three-dimensional spatial path on or within the matrix of the garment material, the corresponding predetermined path spatially associating one or more tension members with at least one ligament of an anatomical joint.

This section describes the properties of the tension members 220, 220', 220" and their interaction with the matrix (weave) of the material from which the garment 200, 200', 200" is made. Figures 2, 3, and 4 show the paths of the tension members 220, 220', 220" in schematic form, but do not show how the tension members 220, 220', 220" are embedded or retained within or on the garment 200, 200', 200". The tension members 220, 220', 220" must be able to move freely within the garment 200, 200', 200" without catching on the garment or unduly distorting the garment. To this end, the tension members 220, 220', 220" are disposed along their paths within conduits (channels) within the material matrix (weave) from which the garments 200, 200', 200" are made. The conduits may comprise natural passageways within the weave of the garment material. In other embodiments, the conduits may be tubular in nature and may be disposed within or attached to the material matrix (weave) of the garments 200, 200', 200". In other embodiments, the conduits may comprise sections of tubing, and are referred to in this disclosure by the phrase "collated tubing". The use of collated tubing can vary the degree of friction between the tension members 220, 220', 220" and the matrix (weave) material of the garments 200, 200', 200". In yet further embodiments, the conduits may be made from a different fabric material than the matrix fabric material of garment 200, 200', 200". Also, in different embodiments, the conduits may be made with a stitch pattern that distinguishes either side of tension member 220, 220', 220" and the tension member path. A particular example of such a stitch pattern is one in which the garment material is sewn together with a seam, and tension member 220, 220', 200" extends longitudinally through the seam.

The tension members 220, 200', 200" may be comprised of multiple individual threads extending along individual conduits, which are joined together before entering the tensioner 240, 240', 240". The tension members 220, 220', 220" may be formed from a material that has substantially less stretch than the material matrix (weave) of the garment. Suitable materials for use in the tension members 220, 220', 220" may be flexible but not longitudinally stretchable. Suitable materials for the tension members 220, 200', 200" include, but are not limited to, stainless steel, nylon, Kevlar®, Teflon®, ultra-high molecular weight polyethylene-based fibers such as Dyneema®, cotton, polyester, and polypropylene, including various fibers such as diamond weave or basket weave, including, but not limited to, Technora®. (Kevlar is a registered trademark of E. I. DU PONT DE NEMOURS AND COMPANY CORPORATION DELAWARE Chestnut Run Plaza, 974 Centre Road WILMINGTON DELAWARE 19805; Teflon is a registered trademark of THE CHEMOURS COMPANY FC, LLC LIMITED LIABILITY COMPANY DELAWARE 1209 ORANGE STREET WILMINGTON DELAWARE 19801; Dyneema is a registered trademark of DSM IP Assets B.V. LIMITED LIABILITY COMPANY NETHERLANDS Het Overloon 1 HEERLEN NETHERLANDS NL6411 TE; Technora is a registered trademark of TEIJIN KABUSHIKI KAISHA (TEIJIN LIMITED) CORPORATION JAPAN 6-7, MIN AMIHOMM ACHI l-CHOME CHUO-KU, OSAKA JAPAN. The conduits (registered trademarks of TEAC) may be formed from the same material as the matrix material of the garment, and may be internally lined with a conduit material that has a lower coefficient of friction with respect to the material of the tension members, allowing the tension members 220, 220', 220" to move as freely as possible. The conduits may be in the form of tubes or butted tubes (series of connected tubes). There are no particular structural restrictions on the cross section of the tubes. Butted tubes are advantageous because they allow for the selection of tubing materials with very low friction, even if they do not stretch. Butted tubing sections allow the garments 200, 200', 200" to move toward each other without excessive crumpling when tension is applied to the tension members 220, 220', 220". As shown in Figures 2, 3, 4 and 5, tensioners 240, 240', 240" may be variously positioned on or within the loops formed by the tension members 220, 220', 220".

Considering that tension members 220, 220', and 220" are free to move within their respective conduits, we return to FIG. 2 to clarify the relationship between fixation member 230 and tension member 220 at point I. To this end, the thigh region of FIG. 2 is shown in greater detail in FIG. 5. In one embodiment, fixation member 230 extends along conduit 232, similar to conduit 222 of tension member 220, from point G to point I. For this arrangement to function as an anchor, fixation member 230 is attached to end 234 of conduit 232 near point I. Note that fixation member 230 is not connected to tension member 220 at point I, as tension member 220 must be free to move within conduit 222. In this arrangement, the portion of tension member 220 extending from point A to point I of tensioner 240, along with the entire fixation member 230, form an anchor extending around the thigh. Because tension member 220 must be able to move freely through point I, the curvature of the path of tension member 220 at point I has an upper limit determined by the flexibility of tension member 220. This contributes to the selection of material for tension member 220, which requires that the material must be highly flexible while being substantially inextensible in the longitudinal direction. A variety of fabrics useful with the particular embodiment of Figures 2 and 5 are selected, including cotton, polyester, and polypropylene, in diamond or basket weave.

The portion 250 of the garment 200 between the securing member 230 and the tensioning member 220 may be formed from a non-stretchable material to prevent tension applied to the securing member 230 by the tensioner 240 from simply stretching the portion 250 of the garment 200 near the area between the securing member 230 and the tensioning member 220. In other embodiments, the end of the securing member 230 near point I may be looped to spread the force applied to the end of the securing member 230 over a wider area and prevent it from pulling or deforming the fabric of the garment 200. Figure 5 also shows that the tensioning member 220 enters the tensioner 240 via a tensioner port 242.

There is considerable flexibility in the selection of the matrix material or fabric for garments 200, 200', 200". There are advantages to using a material that has significant elasticity, such as, but not limited to, spandex or blends of spandex with other fibers, including, but not limited to, cotton. This allows the garment to be intentionally snug, which helps prevent wrinkles when tension members 220, 220', 220" are pulled.

Figures 6A, 6B, and 6C show different embodiments of conduits for use with tension members. For example, using the elements of Figures 2 and 5, Figure 6A shows a seam in the material matrix of garment 200 created by stitches 224, which in this embodiment have conduits 222 extending along the seam in the form of a tube. Tension members 220 extend longitudinally within the conduits 222. The material of the conduits 222 is selected to have a low coefficient of friction with respect to the tension members 220. In more general cases, there may be multiple seams, each with a conduit 222 extending longitudinally therethrough. Each conduit 222 has a strand of tension member 220 extending longitudinally therethrough. While in Figure 6A the conduits 222 are shown as having a circular cross-section, in other embodiments the conduits 222 may have any suitable cross-section that allows the strands of tension member 220 to move substantially freely, while still meeting the ergonomic requirements for the garment. One suitable cross-section is a semicircle or smaller portion of a circle with sufficient curvature to accommodate the strands of tension member 220, with one side flattened for easy integration into garment material 200. As previously mentioned, conduit 222 may be butted, so long as it has very low friction and is non-stretchable. Examples of suitable tubing materials include, but are not limited to, Teflon or silica. In a related embodiment, the strands of tension member 220 are simply sandwiched between two strips of low-friction material within a stitched seam. In a further embodiment, the seam may be formed by joining adjacent material matrices with adhesive, heat sealing, or other bonding mechanisms, with the conduits formed between appropriately spaced seams. Conduits may similarly be implemented within the embodiments of FIGS. 3 and 4.

FIG. 6B illustrates another embodiment of a method for introducing tension member 220 into the matrix material of garment 200. FIG. 6B is an end view of the weave of garment 200. The figure shows three strands of tension member 220 with one end each stitched or woven into the matrix material of garment 200 in four rows. The three strands of tension member 220, 220A, 220B, and 220C, are sandwiched between two elongated strips 270 of low-friction material held together by stitches 260. In this illustration, the material of garment 200 is shown as two sheets. While the illustration is schematic for clarity, the material is actually woven. The stitching fibers are a low-friction material, allowing tension member 220 to slide in all directions relative to the low-friction material. In this embodiment, conduit 222' is formed by strips 270 of low-friction material and stitching 260 of low-friction material. This embodiment may be implemented at seams within the garment 200, or in all areas of the tension member 220 by sandwiching the garment material 200 with a low friction material 270. Conduits may be similarly implemented in the embodiments of Figures 3 and 4.

In Figure 6C, conduit 222" is attached to the surface of garment 200 in the form of aligned semi-cylindrical tubes, with tension member 220 passing through conduit 222". In some embodiments, the base of the tube may be closed or lined with a low-friction material. While tension members 220, 220', 220" are shown with a circular cross-section or profile in Figures 6A, 6B, and 6C, in general embodiments, the profile or cross-sectional shape of tension members 220, 220', 220" is not limited.

In another aspect, as shown in the flowchart of FIG. 7, a method [700] for stabilizing a knee of a human user includes applying a wearable garment 200, 200', 200" around the user's knee. The garment includes a garment foot, a garment knee, tensioners 240, 240', 240" and a closed tension loop 220, 220', 220" disposed in or on the garment 200, 200', 200" and freely movable longitudinally along conduits 222, 222', 222" that are disposed around the garment 200, 200', 200"'. The garment 200, 200', 200" is positioned so that the conduits 222, 222', 222" cross over themselves at least in one location above (points F, F', F") and below (points E, E', E") the knee of the garment 200, 200', 200" between the medial and lateral sides of the front of the leg, and tensioners 240, 240', 240" are positioned to adjust the tension in the loops 220, 220', 220", and in step 720, tensioners 240, 240', 240" are activated to adjust the tension in the loops 220, 220', 220". In one embodiment, the garment 200, 200', 200" is positioned so that the conduits 222, 222', 222" cross over themselves both above (points F, F', F") and below (points E, E', E") the knee of the garment 200, 200', 200".

Step 710 may also be configured to have the user place garments 200, 200', 200" on the user by placing the first loop portion (C, C', C" through D, D', D") against the distal region of the triceps surae muscle of the user's foot, the second loop portion (at points F, F', F") on or above the user's thigh, and the third and fourth loops located on the loops between the first and second portions (between points E, E', E" and points F, F', F") on the medial and lateral sides of the user's patella, adjacent to the two collateral ligaments of the user's knee. Placing the second loop portion may include placing the second loop portion against the back of the user's thigh (see FIG. 4).

In another aspect according to the flowchart of FIG. 8, a method 800 is presented for manufacturing a wearable garment for stabilizing a user's knee, the method including, in step 810, forming a garment that covers at least a portion of the knee, the proximal triceps surae, and the distal portion of the proximal thigh; in step 820, providing a conduit capable of receiving a tension loop either in or on the garment, the conduit being positioned to cross itself between the medial and lateral sides of the front of the garment, at least either below or above the knee of the garment; in step 830, threading a tension member along a path through the conduit; and in step 840, providing a tensioner on or in the loop for adjusting the tension of the loop.

Step 830 of threading the tension member may include threading a substantially inextensible tension member. Step 830 of threading the tension member may include threading a flexible, inextensible tension member. Step 830 of threading the tension member may include threading the tension member made from one or more of PTFE, stainless steel, nylon, Kevlar (registered trademark), ultra-high molecular weight polyethylene-based fibers, and diamond weave fibers. Threading a tension member made from diamond weave fibers may include threading a tension member made from any of cotton, polyester, polypropylene, and Technora (registered trademark).

Providing 840 the conduit may be positioned to cross itself above and below the knee. Shaping 810 the garment may be extending the garment to the user's waist and forming a belt at the waist. Providing a tensioner may be providing a tensioner at the waist. Providing 840 the tensioner on or in the loop may be providing the tensioner at the thigh of the garment.

In a further embodiment shown in FIG. 9, a wearable garment 900 for stabilizing a user's knee 100 includes a closed tension loop 920 disposed for free movement along a conduit 930 disposed within or on the garment 900, the conduit 930 extending along a conduit path having a lateral portion and a medial portion relative to the knee 100, an adjustable tensioner 940 disposed within or on the loop 920 for adjusting tension within the loop 920, the lateral and medial portions of the conduit path passing through the patella 190 of the user's knee 100 adjacent the lateral 170 and medial 180 collateral ligaments of the user's knee 100, respectively, in FIG. 1, and the lateral and medial portions of the conduit path approach each other at one or more points below (point X) and above (point Y) the user's knee 100. The dashed lines in FIG. 9 indicate that the conduit and tension loop are located at the rear of the foot.

The lateral and medial portions of the conduit path may be close to each other at both a first point (point X) below the user's knee 100 and a second point (point Y) above the user's knee 100. Note that the actual conduit portions may overlap at points X and Y, and the lateral and medial portions of the tension loop within the conduit do not meet at points Y and X. The tension loop 920 may be positioned to apply pressure to at least one of the user's lateral collateral ligament 180 and medial collateral ligament 170 when the garment 900 is donned by the user and the tension loop is pulled by actuating the tensioner 940. The conduit 930 may be positioned along a path that substantially encircles the foot at the distal portion of the triceps surae muscle, as shown in FIG. 9 , such that the garment 900 supports the triceps surae muscle. The tension loop 920 may comprise a tensioning member extending along the conduit 930. The tensioner 940 may be positioned on the user's thigh. The tensioning members may be made of a material that is substantially longitudinally inextensible, and the material may be flexible. The loops 920 may be disposed within or on the material of the garment 900, similar to that shown in Figures 6A, 6B, and 6C and the accompanying text. The conduits 930 may be low-friction tubes, which may be arranged side-by-side. As with the embodiment of Figure 4, the tensioning loops 920 in Figure 9 extend substantially around the thighs, thereby providing support for the garment 900 against the thighs.

The arrangement for supporting the user's thighs used in the embodiments shown in Figures 2, 3, and 4 may also be applied to the embodiment of Figure 9. To ensure that the material of garment 900 does not deform and stretch, thereby disrupting the force exerted by tension loop 920, portion 950 of the garment may be made of a suitable non-stretchable material. The embodiment of Figure 9 appears very similar to that of Figure 4, except that loop 920 does not overlap itself.

In another aspect, as depicted in FIG. 10, a method 1000 for manufacturing a wearable garment 900 for stabilizing a user's knee 100 is shown. The method includes the steps of: forming 1010 a garment 900 that at least partially covers the knee 100, the adjacent triceps surae muscle, and the distal portion of the adjacent thigh; providing 1020 a conduit 930 in and/or on the garment for receiving a tension loop 920, the conduit 930 extending along a conduit path having lateral and medial portions relative to the knee 100, the lateral and medial portions of the conduit path approaching each other at least one point, the at least one point being at least one of above and below the user's knee 100; threading 1030 a tension member 220 through the conduit 930 along the path; and providing 1040 a tensioner 940 in and/or on the loop 920 for adjusting tension within the loop 920.

Step 1030 of threading the tension member 220 may comprise threading a substantially inextensible tension member. Step 1030 of threading the tension member 220 may comprise threading a flexible, substantially inextensible tension member. Step 1030 of threading the tension member may comprise threading the tension member made from one or more of PTFE, stainless steel, nylon, Kevlar®, ultra-high molecular weight polyethylene-based fibers, and diamond weave fibers. Threading a tension member made from diamond weave fibers may comprise threading a tension member made from any of cotton, polyester, polypropylene, and Technora®. Step 102 of providing the conduit 930 may comprise positioning the conduit 930 so that the outer and inner portions of the conduit path are adjacent to each other both above and below the user's knee 100. The step 1010 of forming the garment 900 may include extending the garment 900 to the waist of the user, forming a belt around the waist, and placing the tensioner 940 on the belt. The step 1040 of placing the tensioner 940 in or on a loop may include placing the tensioner 940 on the thigh of the garment.

In a variation of the embodiment of FIG. 4, a portion of tension member 220'' may be comprised of a substantially longitudinally inextensible strand of fabric incorporated within the fabric of garment 200''. In FIG. 4, the relevant portion of tension member 220'' comprised of substantially longitudinally inextensible material may be, for example, segments G'' to H''. The remaining portion of tension member 220'' may be comprised of an inextensible strand within a conduit, as already described above. The inextensible strand is supported at both ends by segments G''-H''. Tensioner 240'' may be located at or on one end of segment G''-H''. In this variation of the embodiment of FIG. 4, tensioner 240'' is provided at end H'' of segment G''-H'' of substantially longitudinally inextensible material. Similarly, portions of the tension members 220, 220', 920 in the embodiments of Figures 2, 3, and 9 may be constructed from a substantially longitudinally inextensible material.

As used herein, the phrase "substantially inextensible fabric" refers to a two-dimensionally extensible fabric that is substantially inextensible in at least a first direction. The fabric may have no or limited extensibility in a direction perpendicular to the first direction. Non-limiting examples of such materials include so-called two-way stretch fabrics, which are woven, knitted, or braided from blends of materials including spandex, nylon, Dyneema®, Kevlar®, polyester, Ingeo®, olefin fibers, lyocell, and/or cotton in a manner that allows stretch in the desired dimension. (Ingeo is a registered trademark of NATUREWORKS LLC LIMITED LIABILITY COMPANY DELAWARE 15305 INNETONKA BLVD MINNETONKA MINNESOTA 55345.) "Two-way" stretch, as used herein, refers to stretch in two opposing directions in one dimension while remaining substantially inextensible in a direction, such as perpendicular to the first direction. Other "substantially inextensible fabrics," including, but not limited to, Dyneema® fibers in a two-dimensional mesh embedded within a second fiber or sandwich structure, do not exhibit substantial extensibility in any direction. The inextensibility is considered "substantial" when compared to the inextensibility of the matrix material of the fibers of garment 200. The garment fibers are extensible and expandable when compared to "substantially inextensible fabrics."

Another aspect of the wearable garment for stabilizing the user's knee 100 is illustrated in FIG. 11, which is a variation of the garment shown in FIG. 4. The numbering of FIG. 4 is maintained in FIG. 1. A stabilizing connector 280'' connecting the tensioning member 220'' to the belt 210'' prevents the garment 200'' from being pulled down when adjusting the tension of the tensioning member 220''. The stabilizing connector 280'' can be implemented in a variety of ways, but all embodiments share the same principle of connecting the tensioning member 220'' to the belt 210''. In FIG. 11, the stabilizing connector 280'' is realized as a belt of substantially inextensible fabric that exhibits inextensibility in at least the longitudinal direction to maintain longitudinal tension. While FIG. 11 shows stabilizing connector 280'' extending across the front of garment 200'', stabilizing connector 280'' may also extend across the back of garment 200'' from tensioning member 220'' to belt 210''. In other embodiments, stabilizing connector 280'' may be any substantially inextensible tensioning member disposed within a conduit, and thus may be configured the same as tensioning member 220''.

To prevent excessive deformation or crumpling of garment 200" when adjusting the tension of tension member 220", a substantially non-stretch woven stabilizing portion 250", 260", or 270" is introduced into the fabric or matrix material of garment 200" and attached to conduit 222 (see Figures 6A, 6B, and 6C) of tension member 220" or to the garment material or fabric immediately adjacent to conduit 222. The substantially non-stretch woven fabric used in stabilizing portion 250", 260", or 270" has a non-stretch direction in at least the horizontal direction.

The stabilizing portion 250'' positioned over the front of the foot and proximate the intersection point E'' acts on the forces of the segments E''-C'' and E''-D'' of the tension member 220'' with the major component perpendicular to the path of the tension member 220'' along the two segments E''-C'' and E''-D''. The stabilizing portion 250'' may be fastened to a conduit that supports the tension member 220'' along these two segments E''-C'' and E''-D''. In FIG. 11, the stabilizing portion 250'' extends in a generally triangular shape covering most of the front of the foot below the intersection point E'' between segments E''-C'' and E''-D''. Generally, the stabilizing portion 250'' extends over the anterior portion of the foot below the intersection E'' between segments E''-C'' and E''-D'' to create lateral tension below the intersection E'' between segments E''-C'' and E''-D'' on the anterior portion of the foot.

The stabilizing portion 270'', positioned on the front of the foot and proximate the intersection point F'', acts on the forces of the segments F''-A'' and F''-G'' of the tension member 220'', with the major component perpendicular to the path of the tension member 220'' along the two segments F''-A'' and F''-G''. The stabilizing portion 270'' may be fastened to a conduit that supports the tension member 220'' along these two segments F''-A'' and F''-G''. In FIG. 11, the stabilizing portion 270'' extends in a generally triangular shape covering most of the front of the foot above the intersection point F'', between segments F''-A'' and F''-G''. Generally, the stabilizing portion 270'' extends over the anterior portion of the foot above the intersection F'' between segments F''-A'' and F''-G'' to create lateral tension above the intersection F'' between segments F''-A'' and F''-G'' on the anterior portion of the foot.

The stabilizing portion 260"" located at the rear large portion of the foot near the intersection point F" acts on the lateral and medial segments E"-F" of the tension member 220" with a major component perpendicular to the path of the tension member 220" along these lateral and medial segments E"-F". The stabilizing portion 260" may be fastened to a conduit that supports the tension member 220" along these lateral and medial segments E"-F". In FIG. 11, the stabilizing portion 260" is shown clearly extending in a generally rectangular shape over the rear of the foot above the intersection point E", below the patella 190 between the lateral and medial segments E"-F". In general, stabilizing portion 260'' may extend over the posterior portion of the foot above intersection E'' and below intersection F'' between lateral and medial segments E''-F'' to generate lateral tension above intersection E'' and below intersection F'' between lateral and medial segments E''-F'' on the posterior portion of the foot. Continuing with the embodiment of FIG. 11, considerations of knee joint freedom may limit the area covered by stabilizing portion 260'' between intersections E'' and F''.

In a typical embodiment, stabilizing portions 250", 260", and/or 270" are constructed from substantially horizontally inextensible fibers, and stabilizing portions 250", 260", and/or 270" are positioned to extend between horizontally opposed medial and lateral portions of tensioning member 220". The medial and lateral portions of tensioning member 220" exert lateral tension on each other within the garment when tensioning member 220" is longitudinally tensioned by actuation of tensioner 240". As can be seen in FIG. 11, lateral tension is exerted around the back of the foot between intersections E" and F" in the general area of patella 190, and lateral tension is exerted on the front of the foot above and below intersections E" and F". In the general case, garment 200'' has the non-stretch fabric portions crossing the two segments of tension member 220 laterally in tension with each other horizontally above the foot.

In another embodiment, as shown in FIG. 12, with reference to FIGS. 11 and 6B, garment 200'' can have a tension adjuster 290'' for balancing the tension between at least two threads (strands) of tension member 220''. By way of example, tension member 220'' can be considered to be made up of multiple threads (strands) 220A, 220B, and 220C, as shown in FIG. 6B. FIG. 12 shows one end of tension member 220'', which is to illustrate one end of threads (strands) 220A, 220B, and 220C. By way of non-limiting example, the terminus of tension member 220'' shown in FIG. 12 may be a direct tension adjuster 290'' (see FIG. 11) located at the terminus of tension member 220''. As a user wears the garment and moves their leg, tensioning member 220" flexes, which, without tension adjuster 290", can result in large differences in tension within different strands of tensioning member 220". Adjuster 290" allows tensioning member 220" to flex without creating tension imbalances that disrupt the garment's friction, preventing tensioning member 220" from twisting and compromising user comfort.

In FIG. 11, tension adjuster 290'' is located on the side of the left foot at point C'' and contains the two ends of tension member 220''. In other embodiments, tension adjuster 290'' may be located anywhere on tension member 220'', for example, at point F''. Within tension adjuster 290'', as shown in detail in FIG. 12, two outer threads (outer strands) 220A, 220C are joined to form a single thread that can move freely around pulley 292''. For clarity, some of the reference numerals used in FIG. 6 have been removed in FIG. 12, showing only one end of tension member 220''. The other end is identical but rotated 180 degrees from that shown. Pulley 292'' can rotate about pulley axis 294''. The tension adjuster 290" may be mounted on a substantially inextensible woven base 296" with a non-stretch direction parallel to the strands 220A, 220B, and 220C of the tension member 220". When the tension member 220" has an odd number of strands, as shown in FIG. 12, the non-paired strands may be terminated in or near the tension adjuster 290". While various termination methods for the central thread 220B are possible, FIG. 12 shows a typical termination. FIG. 13 shows a termination method for both ends of the tension member 220" in the tension adjuster 290", where two pulleys 292" are positioned opposite each other to balance the tension between the strands 220A and 220C at the two ends of the tension adjuster 290". While tension adjuster 290'' has only one pulley 292'' at one end of tension member 220'', tension adjuster 290'' in FIG. 11 is required to adjust tension at both ends of tension member 220'', and tension adjuster 290'' in FIG. 11 shows the two-pulley arrangement of tension adjuster 290'' in FIG. 13.

6B and 12 show only one pair of threads (strands) bonded within the tension member 220'', but generally multiple pairs of threads (strands) may be bonded in this manner. These threads may generally be arranged symmetrically, as shown in FIG. 12, with each pair carrying an appropriate pulley to balance the tension between the two bonded threads of each pair. FIG. 12 shows an odd number of threads, i.e., three. In other embodiments, the total number of threads within the tension member 220'' may be even, resulting in only bonded pairs. Generally, the paired threads are arranged such that the pairs are in a substantially symmetrical mirror arrangement about the centerline of the overall tension member. Each pair moves around the appropriate pulley, as described above, to balance the tension between the two constituent threads.

In other embodiments, the adjuster may be any other similar mechanical arrangement that balances the tension of a pair of two threads (strands) that are approximately equidistant from the centerline of the tension member 220'', including, but not limited to, a bent tube (not shown) that allows the joined threads to slide freely within the bent tube.

In other embodiments, the tension adjuster 290'' may be located near the tensioner 240''. In yet another embodiment, the tension adjuster 290'' may be integral with the tensioner 240''. In this case, the two-pulley arrangement of FIG. 13 may be modified as follows: the tension adjustment function may be maintained by rotation of the thread around the pulleys, while the tension may be adjusted by, for example and without limitation, increasing and decreasing the tension by moving the two pulley shafts 294'' toward and away from each other. FIG. 13 illustrates this arrangement, which functions as an integrated combination tensioner and tension adjuster.

In another embodiment, shown in Figures 14A and 14B, the knee joint of Figure 1 is fitted with a medial collateral ligament brace garment 1900, which includes a belt 1910, a left leg tensioner 1940A, a right leg tensioner 1940B, tension members in the form of composite cables 1930A and 1930B movably disposed within conduits 1928A and 1928B, respectively, and conduits 1928A and 1928B partially disposed on or within a woven non-extensible material. Cables 1930A and 1930B are each made from multiple strands of a substantially non-extensible material, such as, but not limited to, PTFE, stainless steel, Nylon®, Kevlar®, one or more ultra-high molecular weight polyethylene-based fibers, and diamond weave fibers. The diamond weave fabric may be, for example, but not limited to, cotton, polyester, polypropylene, and Technora®. The dashed box 100 indicates the area of the left leg in FIG. 1. In this example, the tensile composite cables 1930A and 1930B are the means for generating the necessary force at the knee joint, while the non-stretchable material weave acts as an anchor for either the torso or thigh, and transfers the force generated by the tension in the cables to the knee joint. To accomplish this function, the strands of the cables are substantially non-stretchable, and the composite cables 1930A and 1930B are non-stretchable.

14A and 14B, focusing on applying pressure to the left knee, the four strands of inextensible composite cable 1930A are spread laterally from one another through calf grip 1926A of the left leg. Cable 1930A otherwise runs within conduit 1928A. Inextensible fabric 1924A, which applies pressure to the medial side of the left knee, is attached to conduit 1928A at its two horizontal ends. As tension in cable 1930A increases, the two portions of conduit 1928A are pulled away from one another, correspondingly increasing pressure on the medial side of the left knee through web 1924A.

14A and 14B, conduit 1928A positions cable 1930A around the waist within belt 1910. Upper non-stretch fabric 1922A (see FIG. 14B) positions conduit 1928A. Tensioner 1940A is positioned in line with cable 1930A to adjust the tension in cable 1930A. Tensioner 1940A thereby controls pressure on the left knee and, in this embodiment, is positioned on the right hip. In other embodiments, tensioner 1940A may be positioned elsewhere along the path of conduit 1928A within the line of cable 1930A. The tensioning evener 1942A, described in more detail below, may be positioned anywhere along the path of the conduit 1928A within the line of the cable 1930A so that tension applied by the tensioning evener 1940A is transferred to all strands of the composite cable 1930A via the tensioning evener 1942A. This placement places the tensioning evener 1942A in tensional communication with the tensioning evener 1940A and the strands of the tensioning member 1930A. The following examples describe the tensioning evener 1942A being positioned immediately adjacent to the tensioning evener 1940A. In general, the tensioning evener 1942A may be positioned remotely from the tensioning evener 1940A, but is positioned in tensional communication with the tensioning evener 1940A. The role of tension equalizer 1942A is to ensure that all strands of composite cable 1930A maintain the same tension despite the different individual paths taken by the different strands, e.g., around the triceps surae muscles. How this tension equalization is achieved is described in more detail below.

To apply the appropriate force to the medial collateral ligament (MCL) 170 of FIG. 1, the non-extensible material fabric 1924A of FIG. 14A is positioned to apply a force to the medial side 100 of the joint. The force is generally directed toward the side of the left knee. This stabilizes the left knee joint against medial displacement caused by a problem with the medial collateral ligament 170 of the left knee. Correspondingly, the non-extensible material fabric 1924B is positioned to apply a force to the medial side of the right knee, with the force generally directed toward the side of the right knee. This stabilizes the right knee joint against medial displacement caused by a problem with the medial collateral ligament of the right knee. The composite cable 1930A exits the conduit 1928A and is routed through the calf grip 1926A within individual conduits, partially encircling the triceps surae. The separate strands of the composite cable 1930A converge through the conduit 1928A while partially encircling the triceps surae.

Turning now to the tensioner 1942A, its operation will be described with reference to FIGS. 14A, 14B, 15, and 16A. In FIG. 15, the basic conduit arrangement of FIG. 6B is employed in routing the four strands of the composite cable 1930A of FIGS. 14A and 14B through the calf grip 1926A. In other embodiments, a different number of strands may be employed in the composite cable 1930A. The conduit 1923 within the calf grip 1926A is defined by rows of stitches 1960 that define the lateral limits of the conduit, and two layers of low-friction strips of material 1970 that define the medial and lateral limits perpendicular to the user's skin. The fabric 1970 of the calf grip 1926A may comprise two layers, as shown in FIG. 15, or in some embodiments may be a single layer. Note that the stitches are shown as parallel in FIG. 15. In general, the conduits 1923 are not limited to being parallel, but may follow diverging and converging paths through the fabric 1970 of the calf grip 1926A. These paths may be selected to improve the grip of the calf grip 1926A on the triceps surae. In further embodiments, the conduits used may be of the type shown in FIGS. 6A and 6C.

The fabric 1970 of the calf grip 1926A may be the same as the general fabric of the garment. In other embodiments, the fabric 1970 of the calf grip 1926A may be different from the general fabric of the brace garment 1900. The arrangement shown in FIGS. 14A, 14B, 15, and 16A has a first end of the composite cable 1930A approaching the tensioner 1940A in a clockwise direction (looking down toward the foot) around the waist on the belt 1910, and a second end of the composite cable 1930A approaching the tensioner 1940A in a counterclockwise direction around the waist on the belt 1910. Thus, the first end of the composite cable 1930A approaches the tensioner 1940A from the right side of the drawing in FIG. 14A, and the second end approaches the tensioner 1940A from the left side of the drawing in FIG. 14A.

Figure 14B more clearly illustrates some aspects of the right leg of garment 1900, employing a similar arrangement to the left leg described above. Elements for the right leg are distinguished from elements associated with the left leg by the simple scheme of labeling the associated numeral with a "B" rather than an "A." Tensioner 1940B and tensioner 1942B for the right leg of garment 1900 are positioned on the user's left hip in Figure 14B.

In one embodiment, the second end of composite cable 1930A, approaching tensioner 1940A in a counterclockwise direction (from the left in the drawing of FIG. 14A), may simply be fixed in a stationary manner to tensioner 1940A, either directly or indirectly. In this embodiment, all four strands approaching counterclockwise at the second end of composite cable 1930A are fixed to tensioner 1940A.

Now, approaching the tensioner 1940A from the right side of the drawing in FIG. 14A, we turn to the four strands of the first end of the composite cable 1930A, which are routed through the calf grip 1926A and into the tensioner 1942A. In the embodiment shown in FIGS. 16A-16E, the tensioner 1940A is positioned to move elements of the tensioner 1942 (e.g., pulley 1943A in FIGS. 16A and 16B) and any elements attached thereto along the direction indicated by the double arrow 1949A. This is accomplished by retracting or distracting the non-extensible cable 1941A. To this end, one of the two ends of the non-extensible cable 1941A may be fixedly attached to the tensioner 1940A, while the other end can be retracted or extended by operation of the tensioner 1940A. In other embodiments, both ends of the non-extensible cable 1941A can be retracted or extended by operation of the tensioner 1940A.

FIG. 16A shows one embodiment of the tension equalizer 1942A in more detail. The tension equalizer 1942A includes a Whipple tree 1935A, a device well known since the days of horse-drawn carriages and the subject of several patents issued by the U.S. Patent and Trademark Office. One of its most common uses in the 21st century is equalizing the pressure on automobile windshield wipers. A non-tensioning cable 1948A connects the pulley 1943A to the fulcrum or pivot point of the primary pivot bar 1944A of the Whipple tree 1935A. The term "Whipple bar" is used herein to describe the pivot bar of a Whipple tree. The term "swingle" is also used in some fields to describe the type of pivot bar used in a Whipple tree. In other embodiments, the non-tensioning cable 1941A may directly engage the Whipple tree 1935A, an embodiment in which the pulley 1943A is omitted. The Whipple tree 1935A is described in more detail below. Various arrangements of pulleys and non-extensible cables can be used to move the Whipple tree 1935A closer to or further from the tensioner 1940A.

Whapple tree 1935A, as shown in the specific embodiment of FIG. 16A, is a "double tree" Whipple tree, consisting of two layers of Whipple bars, with bar 1944A in the first layer and bars 1945A and 1946A in the second layer, to accommodate the four strands of composite cable 1930A described in FIGS. 14A and 15. In FIG. 16A, the four strands of composite cable 1930A are shown connected to the second layer of Whipple bars in FIG. 16A. In more general embodiments, Whipple tree 1935A has additional layers of Whipple bars to engage more strands of the composite cable. The term "multi-layer Whipple tree" is used herein to describe a Whipple tree having multiple layers of Whipple bars.

Whipple bar 1944A is free to rotate about its fulcrum or pivot point, as indicated by the rotation arrow associated with Whipple bar 1944A. If the tension in cable 1947A' is higher than the tension in cable 1947A, Whipple bar 1946A will pull Whipple bar 1944A harder than Whipple bar 1945A, and Whipple bar 1944A will rotate clockwise about its pivot point to an angle of rotation where the difference in tension is eliminated. The same effect occurs when the two strands 1930A attached to Whipple bar 1945A are under different amounts of tension. Whipple bar 1945A will rotate about its indicated pivot point to an angle of rotation where the tension in the two strands attached to Whipple bar 1945A is equal. The same behavior holds true for Whipple bar 1946A with respect to any difference in tension between the two strands 1930A attached to it.

14A, 14B, 15, and 16A show a total of four strands for the composite cable 1930A. In general, any integer N>1 strands may be connected to the Whipple tree 1942A to balance tension by this general means. To employ three strands 1930A, two strands 1930A may be attached to the Whipple bar 1945A, while the Whipple bar 1946A may be omitted and the third strand 1930A may be attached directly to the Whipple bar 1944A. To employ more than four strands, additional layers of Whipple bars may be placed between the strands 1930A and the Whipple bars 1945A and 1946A in FIG. 16A, resulting in a "triple tree" Whipple tree. There is no conceptual limit to the number of strands in composite cable 1930A, and tension balancing in this manner can be achieved by a generalized Whipple-Tree Ebner.

While FIG. 16A employs a lever-and-fulcrum-based Whipple tree 1935A to illustrate the concept, other embodiments of the tension equalizer 1942A may employ other arrangements of devices that allow the strands to move or slide, including devices with holes through which the strands can pass. Suitable devices of this type include, but are not limited to, pulleys, threaded beads, rings, grommets, blocks, loops of non-stretchable fabric, and other cable or strand loops. The term "block" is used herein to specifically describe single- or double-hole blocks used in "block and tackle." The devices may have a connection mechanism that allows them to engage with another functionally similar device. The mechanism connecting them to another functionally similar device may be a substantially non-stretchable cable, or a screw, or a strand. In some embodiments, the connection mechanism may be a cable of the same material as the composite cable 1930A or the strands of the cable 1930A.

The calf grip 1926A may be made from a stretchable material, including, for example, rubber, but this should avoid employing laterally extending strands of the composite cable 1930A and tensioner 1942A. Such an attempt at proper grip behavior would not solve the problem of stretchable materials being customized for the wearer of the brace garment 1900. The use of laterally extending strands of the composite cable 1930A and tensioner 1942A overcomes that limitation.

16B, we turn to an alternative embodiment of the tensioner 1942A concept of FIG. 16A. In FIG. 16B, tensioner 1940A is arranged to move the assembly of pulleys 1943A, 1944A, 1945A, and 1946A along the direction indicated by double arrow 1949A. This is accomplished by retracting or extending non-extensible cable 1941A. To this end, one of the two ends of non-extensible cable 1941A may be fixedly attached to tensioner 1940A, while the other end can be retracted or extended by operation of tensioner 1940A. In other embodiments, both ends of non-extensible cable 1941A can be retracted or extended by operation of tensioner 1940A. Non-extensible cable 1948A joins pulley 1943A to pulley 2044A. In other embodiments, the non-extensible cable 1941A may directly engage the pulley 2044A to slide over the pulley 2044A portion, an embodiment in which the pulley 1943A is omitted. Various arrangements of the pulleys and non-extensible cable may be employed to move the pulley 2044A closer to or further from the tensioner 1940A.

The four strands of inextensible composite cable 1930A are actually two looped strands, each folded over on itself, with one strand wrapped around pulley 2045A and the other wrapped around pulley 2046A, as shown in FIG. 16B. As the ends of each of the two strands navigate the entire predetermined path of composite cable 1930A around the user's left leg and body, they approach tensioner 1940A in a clockwise direction as already described above, until they are secured to tensioner 1940A upon reaching it. Pulleys 2045A and 2046A are connected by inextensible cable 2047A, which engages pulley 2044A. If the tension in strand 1930A folded around pulley 2045A is not equal on both sides of pulley 2045A, strand 1930A can be moved around pulley 2045A by sliding or rotating pulley 2045A until the tension is equal. The same is true for strand 1930A folded around pulley 2046A.

If the resolved tension in strand 1930A relative to pulley 2045A and the resolved tension in strand 1930A relative to pulley 2046A are unbalanced, cable 2047A will slide over pulley 2044A, or the two pulleys will move relative to each other to rotate pulley 2044A and equalize the tension in strand 1930A. This tension-equalizing arrangement functions similarly to Whipple tree 1935A in FIG. 16A. The degree of rotation of the various pulleys depends on the tension differences and pulley radii, as previously discussed. The difference in the embodiment of FIG. 16B is that Whipple bars 1944A, 1945A, and 1946A in FIG. 16A are replaced by pulleys 2044A, 2045A, and 2046A, and cables 1947A and 1947A' are replaced by a single cable 2047A. The particular embodiment in FIG. 16B is also a "double tree" (two-layer) Whipple tree 2035A. Like the arrangement of FIG. 16A, the embodiment of FIG. 16B can similarly be expanded to include more layers of pulleys and a larger or odd number of strands. In general, the Whipple tree embodiment of FIG. 16B is another example of a multi-layer Whipple tree.

A further embodiment of tensioner 1942A is shown in FIG. 16C, in which the pulley of FIG. 16B is replaced by a ring around which the cable and strand are wound. The ring may be of any suitable material capable of withstanding the applied tension, including, but not limited to, a metal ring, a plastic ring, and a fabric ring or loop. More specifically, cable 2047A of FIG. 16B is replaced by a looped, non-extensible cable 2147A. As in FIG. 16B, two strands 1930A are employed that are folded back on themselves, and the strands are threaded through rings 2045A' and 2046A' located on either end of non-extensible cable 2147A, thereby eliminating the need for pulleys 2045A and 2046A. Non-extensible cable 1941A, under tension from tensioner 1940A, is threaded directly through ring 2044A', and cable 2147A is threaded directly through ring 2044A'. Pulley 1943A in FIG. 16B is omitted, as is cable 1948A in FIG. 16B. In this embodiment, tensioner 1942A and Whipple tree 2035A' do not include pulleys or Whipple bars, and the operation of the device is based solely on cables and strands sliding within rings of the type described above. Nevertheless, its function is similar to that of FIG. 16B. Paralleling the arrangements of FIGS. 16A and 16B, the embodiment of FIG. 16C can similarly be expanded to include more layers of rings and larger or odd numbers of strands. In general, the ring-based Whipple tree embodiment of FIG. 16C is another example of a multi-layer Whipple tree.

A further embodiment of the tensioning evener 1942A, derived from the arrangement of FIG. 16C, is shown in FIG. 16D, in which the rings of FIG. 16C are replaced by loops within the cables and strands. As in FIG. 16D, two strands 1930A folded back on themselves are employed and threaded through the ends of non-extensible cable 2147A, thereby eliminating the need for rings 2045A' and 2046A'. Cable 2147A is threaded directly through cable 1941A. In this embodiment, tensioning evener 1942A and Whipple tree 2035A'' do not include rings, pulleys, or Whipple bars, and operation of the device is solely based on the cables and strands sliding within loops of other strands or cables. Nevertheless, its function is similar to that of FIG. 16C. Paralleling the arrangements of FIGS. 16A, 16B, and 16C, the embodiment of FIG. 16D can similarly be extended to encompass more layers of cable loops and larger or odd numbers of strands. In general, the loop-based Whipple tree embodiment of FIG. 16D is another example of a multi-layer Whipple tree.

Alternative embodiments of tensioner 1942A and its interaction with tensioner 1940A include the example shown in FIG. 16E. For clarity, this example is shown using pulleys like in FIG. 16B. In this embodiment, non-stretchable cable 1941A, which is stretched and contracted by tensioner 1940A to adjust tension in the system, is also engaged with both pulley 2245A and pulley 2246A. Between pulley 2245A and pulley 2246A, cable 1941A also engages pulley 2244A. Cable 2248A simply fixedly attaches pulley 2244A to tensioner 1940A. As in FIG. 16B, cable strand 1930A is also engaged with pulleys 2245A and 2246A. Comparison with Figures 16B and 16C shows that this arrangement omits cables 2047A and 2147A, respectively, and assigns their tension uniformity function to cable 1941A of Whipple tree 2135A. Note that the movement of cables 1941A and strands 1930A in this embodiment may be a combination of sliding and rotating the pulleys with which they are engaged. This arrangement remains a two-layer Whipple tree and is therefore also an example of a multi-layer Whipple tree. Paralleling the arrangements of Figures 16A, 16B, 16C, and 16D, the embodiment of Figure 16E can similarly be expanded to include more layers of pulleys and larger or odd numbers of strands.

16F shows a variation of the embodiment of FIG. 16E, in which cable 2248A and pulley 2244A of FIG. 16E are simply replaced with eyelet 2344A, a representation specifically chosen to show that eyelet 2344A serves the same purpose in FIG. 16F as pulley 2244A serves in FIG. 16E. Eyelet 2344A may be made from any material capable of withstanding the tension applied thereto. Paralleling the arrangements of FIGS. 16A, 16B, 16C, 16D, and 16E, the embodiment of FIG. 16F may similarly be extended to include more layers of pulleys and larger or odd numbers of strands. For example, an additional eyelet 2344A could be added to tensioner 1940, and cable 1941A could engage a third pulley positioned between pulleys 2245A and 2246A, which would engage another strand 1930A, thereby allowing six strands (i.e., two more double strands) to be threaded through calf grip 1926A of FIGS. 14A and 14B. Arrangement 2235A of FIG. 16F, and its extensions described herein, remains a two-layer Whipple tree and is therefore also an example of a multi-layer Whipple tree. As shown in FIG. 16D with respect to FIGS. 16A, 16B, and 16C, the pulleys of FIGS. 16D and 16E may be replaced by appropriately positioned cable loops. Some embodiments, such as the embodiment shown in FIG. 16E, may have a mechanical advantage in that the force exerted on cable 1941A by tensioner 1940A results in a greater force on cable strand 1930A.

FIG. 17A shows how an alternative tension equalizer 1942A including a three-tier Whipple tree 2335A is used to equalize tension in eight strands. The eight strands 1930A originate from four strands looped over a pulley at one end of a composite cable 1930, then travel through a conduit 1928A and are individually threaded through the calf grip 1926A of FIGS. 14A and 14B. They then travel as composite cable 1930A through conduit 1928A and engage with tensioner 1940A at the other end of cable 1930A using the different extendible fixation methods already described above. This three-tier Whipple tree may be implemented in any of the forms described with reference to FIGS. 16A-16F. For clarity, a pulley-based implementation built on the system of FIG. 16B is chosen. In this embodiment, two inextensible cables 1932A are secured at their four ends to four pulleys 1934A. Eight strands 1930A are engaged with the pulleys 1934A. The tension equalization function of this embodiment proceeds as previously described in FIG. 17A, except that there are additional layers of pulleys 1934A and cables 1932A to balance the tension in the strands 1930A. In all other respects, the embodiment of FIG. 17A is the same as the embodiment of FIG. 16B, and the remaining elements are numbered the same as the embodiment of FIG. 16B.

Figure 17B shows yet another embodiment of a three-layer Whipple tree arrangement 2335A' based on the Whipple tree arrangement of Figure 17A. In the embodiment of Figure 17B, pulley 1394A is not present. Instead, two of the four pulleys 1934 are functionally replaced by a pair of interlocking loops 1934A' of continuous strands 1930A, with strands 1930A routed over pulleys 2045A and 2046A. This remains a three-layer Whipple tree, but the third layer, unlike that of Figure 17A, has only two pivot points. To convert the embodiment of Figure 17B to a Whipple tree evenner, in which the third layer would have four pivot points, the same arrangement used for cable 2147A of Figure 16C may be employed for each of pulleys 2045A and 2046A. In this arrangement, none of the cables 1930A are engaged with a pulley, and each has a loop arrangement 1934A', for a total of four.

Figure 17C shows a further embodiment of a three-layer Whipple tree arrangement 2335A'' based on the Whipple tree arrangement of Figure 16D and employing the looped strand 1930A configuration and loop 1934A' of Figure 17B. The reference numerals of Figure 16D are used for parts of the structure that are identical to that embodiment.

As already described for the two-layer Whipple tree with reference to Figures 16B-16F, the three-layer arrangement may also use other mechanical variations, including rings, grommets, or blocks of suitable tension-resistant material, including fabric, to perform the same function. The embodiments of Figures 17A, 17B, and 17CC also rely on a multi-layer Whipple tree tension liner.

Figures 16A-16F and 17A-17 all describe a multi-layer Whipple Tree tensioning evenner using the left leg configuration of garment 1900 in Figures 14A and 14B. The same basic configuration can be made for a multi-layer Whipple Tree tensioning evenner 1942B for use with right leg tensioning. Figures 14A and 14B show inextensible fabrics 1942A and 1942B positioned to apply pressure to the medial aspects of the left and right knees, respectively. Similar inextensible fabrics may be positioned with appropriate tension members, conduits, inextensible cables, tensioners, and tensioning evenners to apply pressure to the lateral sides of the two knees. Pairs of tensioning evenners can be implemented according to Figures 16A-16F and 17A-17C. Some garments may need to implement only some of the pairs of tension equalizers according to Figures 16A-16F and 17A-17C. Some garment embodiments may include placement of non-stretch fabric on both the lateral and medial sides, as described above, to simultaneously apply pressure to both the lateral and medial sides of one or both knees.

The example of a human knee has been used above to describe brace garments 200, 200'', and 1900 for stabilizing a human knee. The concepts described herein, however, are not limited to the human knee and may be applied to any anatomical joint to be stabilized, including, for example, but not limited to, a human ankle, elbow, wrist, shoulder, hip, neck, spine, and one or more vertebrae. FIGS. 18A and 18B show an example of a right shoulder joint stabilized by a shoulder brace garment 2400 that encases the wearer's upper torso and adjacent portions of the upper arm, thereby encasing the shoulder. Inextensible fabric 2424 provides pressure to a selected, injured, or unstable shoulder joint under the action of a tension member in the form of inextensible fabric 2424 wrapped around the torso to secure against the wearer's rib cage on the side of the torso opposite the side of the torso where inextensible fabric 2424 is positioned. As shown in Figures 14A and 14B, the inextensible cable 2430 may be divided into multiple constituent strands extending laterally from one another, with the four strands 2430 used in Figures 18A and 18B being routed through grips 2426 in the strand conduits previously described with reference to Figures 14A and 14B. The fabric of the grips 2426A may be the same as the general fabric of the garment 2400. In other embodiments, the fabric of the grips 2426 may be different from the general fabric of the brace garment 2400. The tensioner 2440 may be the same as the tensioner in the embodiment shown in Figures 14A and 14B. The tensioner 2442, in conjunction with the tensioning member strands and tensioner, may be the same as the tensioner of Figures 16A-16F in terms of tension. As described with reference to the tension eveners of Figures 16A-16F and 17A-17C, the number of strands may be any number greater than or equal to two, and the tension evener 2442 may be a Whipple tree, including a multi-layer Whipple tree.

19A and 19B show another embodiment of a right shoulder joint stabilized by a shoulder brace garment 2600 that encircles the wearer's upper torso and encircles the adjacent portion of the upper arm, thereby encircling the shoulder. The shoulder portion 2622 of the shoulder brace garment 2600 applies pressure to a selected injured or unstable shoulder joint under the action of a composite tension member that follows a path around the torso to anchor it at the wearer's rib cage on the side of the torso opposite that on which the shoulder portion 2622 is located. In this embodiment, the tension member includes the shoulder portion 2622; straps 2610A, 2610B, 2620B, 2620A, and 2620B; Whipple tree tensioners 2642A and 2642B; and a tensioner with two interengaging portions of hook-and-loop fabric 2626 and 2640. Tension is applied by pulling sections 2626 and 2640 in generally opposite directions over one another, interengaging them. Whippletree evners 2642A and 2642B balance tension along the described paths by straps 2610A and 2620A on the one hand, and straps 2610B and 2620B on the other, with Whippletree substantially inextensible threads traveling through eyelets 2644, which act as threading members. While garment 2600 is shown as enveloping the entire upper body, it need not envelop the unsupported left shoulder. In principle, brace garment 2600 need not comprise a T-shirt as shown in FIGS. 19A and 19B, but may comprise only the other components numbered herein. As noted, the embodiment of FIGS. 19A and 19B, unlike the embodiment of FIGS. 18A and 18B, does not require the use of any conduits for tension members, nor does it have separate partial tensioners or separate partial tension equalizers. Similar to tension equalizers, tension is distributed. In other embodiments, the hook-and-loop tensioners described by fabric portions 2626 and 2640 can be replaced by other tensioner arrangements that engage with Whipple tree equalizers 2642A and 2642B. The tensioners can be similar to those in the embodiment shown in FIGS. 14A and 14B. Whipple tree equalizers 2642A and 2642B can be replaced by any of the Whipple tree equalizers of FIGS. 16A-16F, or by any tension equalizers that can engage with the tensioners and straps 2610A, 2610B, 2620A, and 2620B.

Figure 20 shows a wearable brace garment 3100 for a human ankle. In this embodiment, a left foot is used as an example, although a mirror image of the structure of the wearable brace garment 3100 would be suitable for the right foot (not shown). The lateral side of the foot is shown, while the medial side has the same arrangement, with non-stretchable fabrics 3150 and 3151 extending under the foot from lateral to medial, non-stretchable fabric 3152 extending over the foot from lateral to medial, non-stretchable fabric 3153 extending across the front of the lower leg from lateral to medial, and non-stretchable fabric 3154 extending across the back of the lower leg from lateral to medial. Therefore, the arrangement of the tension members described below is substantially the same on the lateral side and the medial side of the leg shown in Figure 20.

In addition to the non-stretch fabrics 3150, 3151, 3152, 3153, and 3154 already described, the non-stretch fabric 3155 (and its equivalent on the inside of the leg) may be integral with the fabric 3150 or may be a separate non-stretch fabric that engages with the non-stretch fabric 3150 via a hook-and-loop fastener or other arrangement. The anchor band 3110 is worn around the lower leg above the ankle and may be fastened around the leg by any of a variety of arrangements, including the overlapping hook-and-loop fastener arrangement shown in FIG. 20. The non-stretch fabric 3155 (and its equivalent on the inside of the leg) may be attached to the anchor band 3110 via a hook-and-loop fastener arrangement or any other stable attachment mechanism.

To apply the appropriate stabilizing force to the ankle joint, a tensioner 3120 is provided on the anchor band 3110. The tensioner 3210 applies the necessary force to the inextensible fabric 3150, 3151, 3152, 3153, and 3154 by means of two loops of substantially inextensible yarn that engage a Whipple tree arrangement with inextensible yarn 3160. The outer loop of the ankle is labeled 3170. The inner loop, not visible in FIG. 20 and hidden by the foot, follows a path that is a substantial mirror image of the path of yarn 3170. When the tensioner 3120 is tightened, the substantially inextensible loop 3170 (and its counterpart on the inside of the leg) slides through the thread-passable members on the inextensible fabrics 3150, 3151, 3152, 3153, and 3154 via the Whippletree loop 3160, balancing the tension between the loop 3170 and its counterpart on the inside of the leg. This also balances the forces applied between the lateral and medial sides of the ankle joint. The wearable brace garment 3100 may include a sock 3190 to which the aforementioned elements are attached. The sock 3190 may be a full sock or a toeless sock.

21A and 21B show a wearable brace garment 33000 for a human wrist. The brace garment 3300 comprises a hand anchor band 3310 secured around the hand by a hook-and-loop or other removable fastening arrangement, and an arm anchor band 3350 secured around the forearm by a hook-and-loop or other removable fastening arrangement. Dorsal straps 3330A and 3330B are attached at their distal ends to the hand anchor band 3310 on the dorsal side of the hand. The attachment may be permanent or removable via hook-and-loop type fasteners. Dorsal straps 3330A and 3330B may be non-extensible. Palm straps 3330C and 3330D are attached at their distal ends to the hand anchor band 3310 on the palmar side of the hand. The attachment may be permanent or removable via hook-and-loop type fasteners. Palm straps 3330C and 3330D may be non-extensible. All four straps 3330A, 3330B, 3330C, and 3330D may have respective loops or conduits 3344A, 3344B, 3344C, and 3344D at their proximal ends.

Tensioner 3320 is positioned on the back side of arm anchor band 3350 and engages straps 3330A, 3330B, 3330C, and 3330D by substantially inextensible cables or threads 3342A and 3342B. Cable 3342A passes through loops or threadable members 3344A and 3344B and loop or threadable member 3344H positioned on the back side of arm anchor band 3350. One end of cable 3342A is tied to arm anchor band 3350. The other end of cable 3342A can be connected to tensioner 3320. As the tension in cable 3342A increases with the operation of tensioner 3320, the Whipple tree tensioner formed by cable 3342A and threadable members 3344A, 3344B, and 3344H ensures that the tension in dorsal strap 3330A and the tension in dorsal strap 3330B are the same.

One end of cable 3342B is tied to arm anchor band 3350, and the other end can be connected to tensioner 3320, allowing tensioner 3320 to adjust the tension in cable 3342B. The Whipple Tree tensioner formed by cable 3342B in combination with threadable members 3344C, 3344D, 3344E, 3344F, and 3344G on the volar side of brace garment 3300 ensures that the tension in palm strap 3330C is the same as the tension in palm strap 3330D. The symbols a, b, c, and d aid in tracing the routing of cable 3342 around either side of anchor band 3350 adjacent to the wrist as shown in FIGS. 21A and 3342AB. Adjusting tensioner 3320 applies force to the wrist to stabilize it. The brace garment 3300 may include a glove 3310 to which the above-described arrangement may be attached. The glove 3310 may be a full glove or a fingerless glove.

22A, 22B, and 22C show a wearable brace garment 3500 for stabilizing a human elbow. In FIGS. 22A, 22B, and 22C, the brace garment 3500 is shown in different perspectives as applied to the right elbow of a human wearer. FIG. 22A shows a front view of the right elbow from the palm side of the right hand, while FIG. 22B shows a back view of the same elbow from the dorsal side of the right hand. FIG. 22C shows the same right arm and hand in a third perspective view with the biceps contracted. A forearm anchor band 3510 and an upper arm anchor band 3550 are releasably secured to the forearm and upper arm, respectively. To this end, both anchor bands may be provided with hook-and-loop or other members to facilitate attachment to the two portions of the arm. As shown in FIGS. 22B and 22C, a tensioner 3520 is positioned on the dorsal side of the forearm anchor band 3510. One end of substantially inextensible cable 3560 is attached to forearm anchor band 3510, and the other end of cable 3560 engages tensioner 3520, allowing tensioner 3520 to adjust the tension in cable 3560. Substantially inextensible cables 3570A and 3570B both have both ends attached to upper arm anchor band 3550. Cables 3570A and 3570BB are both looped through cable 3560. Cable 3570A is further looped through threadable member 3544A on forearm anchor band 3510 to guide it. Cable 3570B is further looped through threadable member 3544B on forearm anchor band 3510 to guide it.

Cables 3570A and 3570B may be routed along a conduit extending between the forearm anchor band 3510 and the humeral anchor band 3550. In some embodiments, the brace garment 3500 may further include a tubular garment 3590 extending from the proximal end of the humeral anchor band 3550 to the distal end of the forearm anchor band 3510. The conduits for cables 3570A and 3570B may be disposed on or within the tubular garment 3590. The conduits may be implemented according to the arrangements described in Figures 6A, 6B, or 6C.

Cables 3570A and 3570B, along with cable 3560 and passable members 3544A and 3544B, comprise a Whipple Tree equalizer that serves to equalize the tension in cables 3570A and 3570B. Adjusting tensioner 3520 adjusts the tension in cables 3570A and 3570B, and the Whipple Tree equalizer automatically ensures that the tension in each of the two cables 3570A and 3570B is the same. The tension in cables 3570A and 3570B creates the force necessary to stabilize the user's elbow joint.

14A-22C illustrate aspects and embodiments of wearable brace garments 1900, 2400, 2600, 3100, 3200, 3500 for stabilizing a wearer's joint, where the garments are positioned to at least partially encase the joint. The garments may include tension members positioned along a three-dimensional spatial path centered on the joint. The tension members vary between embodiments but may include multiple substantially inextensible strands along their length. The brace garments may further include tensioners positioned on the garment to adjust tension within the tension members. Tensioners may vary between embodiments but are exemplified by tensioners 1940A, 1940B, 2440, 3120, 3320, and 3520 and the hook-and-loop fastener arrangements of FIGS. 19A and 19B. The brace garment may further include tension equalizers 1942A, 1942B, 2442, 3642A, 2642B (as well as the cable arrangements of FIGS. 20-22C) that are tensionally positioned on the garment in conjunction with the tensioner and the strands of the tension member to evenly distribute tension among the multiple inextensible strands of the tension member.

The tension evener may include a Whipple tree, which may be a multi-layer Whipple tree. Whipple trees suitable for use as tension eveners for various embodiments are shown in Figures 12 and 13 and 16A-17C. The Whipple tree may include a pulley (e.g., 1943A, 2044A, 2045A, 2046A) positioned to engage with the substantially inextensible strand of the tension member. The pulley may be made of wood, metal, or polymer. In some embodiments, the Whipple tree may include one of an injection-molded pulley and a three-dimensionally printed pulley. The Whipple tree may include a threadable member positioned to engage with the substantially inextensible strand of the tension member. The threadable member may be a bead, block, ring, eyelet, and/or Whipple bar positioned to engage with the substantially inextensible strand of the tension member. The beads, blocks, rings, grommets, or Whipple bars may be made of wood, metal, or polymer. The threadable members may be injection molded or three-dimensionally printed. The Whipple trees may include loops of substantially inextensible fabric positioned to engage with substantially inextensible strands of the tension member. The Whipple trees may be configured to provide a mechanical advantage.

The brace garment may include a woven fabric portion including laterally splayed strands, each strand disposed within a corresponding strand conduit on or within the garment. The garment may be made of garment material, and each conduit may have a coefficient of friction lower than the coefficient of friction of the garment material relative to the strand. Each conduit may comprise a tube of a material different from the garment material. The three-dimensional spatial path of the tension member may extend around the limb at the joint. The three-dimensional spatial path of the tension member may be positioned such that tension within the tension member creates a compressive force proximate the joint. The joint may be one of the wearer's ankle, elbow, wrist, shoulder, hip, neck, spine, and one or more vertebrae. The tensioner may be configured to provide a mechanical advantage when applying tension to the tensioner.

14A and 14B, and 18A and 18B, depict wearable brace garments 1900, 2400 for stabilizing a wearer's articulating joint, the garments 1900, 2400 being positioned to at least partially encase the joint. The garments include tension members positioned along a three-dimensional spatial path around the joint in conduits on or within the garments 1900, 2400, the tension members including a plurality of substantially inextensible strands 1930A, 1930B, 2430 extending longitudinally, and woven portions 1926A, 1926B, 2426 including laterally extending strands (each strand disposed within a corresponding strand conduit), and a tension member positioned on the garments 1900, 2400 and configured to adjust tension within the tension members. and tension equalizers 1942A, 1942B, 2442 disposed on the garment 1900, 2400 in tension communication with the tensioners 1940A, 1940B, 2440 and the tension member strands 1930A, 1930B, 2430, the tension equalizers 1942A, 1942B, 2442 being positioned to equalize tension among the plurality of inextensible strands 1930A, 1930B, 2430 of the tension member.

The tensioner may be a Whipple tree 1935A, 2035A, 2035A', 2035A'', 2135A, 2235A, 2335A, 2335A', 2335A'', which is a multi-layer Whipple tree. The Whipple tree may be, more specifically, a two-layer Whipple tree or a three-layer Whipple tree, and the Whipple tree may employ one or more of a pulley and a threadable member. The threadable member may include one or more of a bead, a ring, an eyelet, a block, a loop of inextensible fabric, a loop of inextensible cable, and a Whipple bar for engaging the inextensible strand 1930A, 2430 of the tension member. The pulleys, threadable beads, rings, grommets, blocks, and Whipple bars may be formed from any material capable of withstanding the applied tension, including, but not limited to, wood, metal, plastic, and other suitable polymeric materials. These elements may be formed by, for example, but not limited to, injection molding or three-dimensional printing techniques.

The garments 1900, 2400 may be made of a garment material, and each conduit may have a coefficient of friction with the strands 1930A, 2430 that is lower than the coefficient of friction of the garment material with respect to the strands 1930A, 2430. Each of the conduits may comprise a tube of a material different from the garment material. The three-dimensional spatial path of the tension members may be arranged so that tension within the tension members creates a direct compressive force at the joint.

The tensioner 1940A, 2440 may be engaged with the tensioner 1940A, 2442 for mechanical convenience in applying tension to the tensioner, as shown for tensioner 1940A in FIGS. 16A, 16B, 16C, and 16D and FIGS. 17A, 17B, and 17C. The joint may be one of the wearer's ankle, elbow, wrist, shoulder, hip, neck, spine, and one or more vertebrae.

One application of the brace garment presented here is best illustrated by Figure 1, which shows a human left knee with the patella, or kneecap, having various adhesions removed for clarity of the internal structure. Osteoarthritis is a painful condition in which the cartilage on the medial side of the articular cartilage 140 and the lateral side of the articular cartilage 140 on the tibia 120 wears away. Generally, the medial side of the articular cartilage 140 tends to be more prone to this condition. One possible treatment for this condition is to reduce the pressure exerted by the femur 110 on what remains of the medial side of the articular cartilage 140. This can be achieved by using a brace garment of the type shown on the left leg in Figure 14A, but instead applied to the lateral or lateral side of the left knee joint, rather than the medial side as depicted in Figure 14A. The force applied to the lateral side of the left knee joint "unloads" pressure on the medial side of the articular cartilage 140, reducing wear and pain. Similar arrangements can be implemented for other joints in the human anatomy.

While this invention has been described as having an exemplary design, the invention may be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover various modifications, uses, and adaptations of the invention using its general principles, and are intended to be within the scope of the invention. Further, this application is intended to cover departures from the present disclosure that come within known or customary practice in the art to which this invention pertains.

Claims (22)

1. A wearable brace garment for stabilizing a joint of a wearer, the wearable brace garment configured to at least partially encase the joint;
The wearable brace garment comprises:
a tension member configured to be positioned along a three-dimensional spatial path about the joint, the tension member having a plurality of substantially inextensible strands along its length, the plurality of strands configured to extend both lateral and medial to the joint;
a tensioner disposed on the wearable brace garment and configured to adjust tension within the tension member;
a tension equalizer disposed on the wearable brace garment in tensional communication with the tensioner and all of the plurality of inextensible strands of the tension member, the tension equalizer equalizing tension among all of the plurality of inextensible strands of the tension member, the tension member and tension equalizer being configured to equalize the support force applied by the plurality of strands to the lateral and medial sides of the joint . In the wearable brace garment described in claim 1, the tensioner is characterized by having a Whipple tree. In the wearable brace garment described in claim 2, the Whipple tree is a multi-layer Whipple tree. 3. The wearable brace garment of claim 2, wherein the Whipple tree includes a pulley positioned to engage the substantially inextensible strand of the tension member. 5. The wearable brace garment of claim 4, wherein the pulley is made of wood, metal, or polymer. 3. The wearable brace garment of claim 2, wherein the Whipple tree is comprised of either an injection molded pulley or a three-dimensionally printed pulley . 3. The wearable brace garment of claim 2, wherein the Whipple tree includes a threadable member positioned to engage the substantially inextensible strand of the tension member. 8. The wearable brace garment of claim 7, wherein the threadable member includes one or more of beads, blocks, rings, grommets, and Whipple bars positioned to engage the substantially inextensible strands of the tension member. 9. The wearable brace garment of claim 8, wherein one or more of the beads, blocks, rings, grommets, and Whipple bars are made from one of wood, metal, and polymer. 8. The wearable brace garment of claim 7, wherein the threadable member is injection molded or three-dimensionally printed. 3. The wearable brace garment of claim 2, wherein the Whipple tree has loops of substantially inextensible fabric arranged to engage with the substantially inextensible strands of the tension member. 3. The wearable brace garment of claim 2, wherein the Whipple tree includes a loop of inextensible cable positioned to engage the substantially inextensible strand of the tension member. 3. The wearable brace garment of claim 2, wherein the Whipple tree provides a mechanical advantage. 10. The wearable brace garment of claim 1, further comprising a woven portion including laterally extending strands, each strand disposed within a corresponding strand conduit on or within the wearable garment. 15. The wearable brace garment of claim 14, wherein the wearable brace garment is made of a wearable brace garment material having a coefficient of friction, and each conduit has a lower coefficient of friction with the inextensible strands than the coefficient of friction of the wearable brace garment material with the inextensible strands. 15. The wearable brace garment of claim 14, wherein each conduit comprises a tube of a material different from the wearable brace garment material. 15. The wearable brace garment of claim 14, wherein the tensioner comprises a Whipple tree. 2. The wearable brace garment of claim 1, wherein the three-dimensional spatial path of the tension member extends around the limb at the joint. 2. The wearable brace garment of claim 1, wherein the three-dimensional spatial path of the tension member is arranged so that tension within the tension member generates a compressive force near the joint. 2. The wearable brace garment of claim 1, wherein the joint is one of the wearer's ankle, elbow, wrist, shoulder, hip, neck, spine, and one or more vertebrae. 21. The brace garment of claim 20, wherein the tensioner comprises a Whipple tree. 10. The wearable brace garment of claim 1, wherein the tensioner provides a mechanical advantage in tensioning the tensioner.