Biomechanics comparison of modified posterior tibial splint hinge knee brace and PCL brace in PCL insufficiency: Cadaveric study

Biomechanics comparison of modified posterior tibial splint hinge knee brace and PCL brace in PCL insufficiency: Cadaveric study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Biomechanics comparison of modified posterior tibial splint hinge knee brace and PCL brace in PCL insufficiency: Cadaveric study Jiradeth Tanulugpairoj, Sorasitch Chiravichitchai, Suriya Laksawut, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8007480/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Posterior cruciate ligament (PCL) is an intra-articular structure. Non-operative treatment with PCL brace is mainstay treatment for acute isolated PCL injury. Commercial PCL brace typically cost expensive. We developed an applied PCL brace for substituted commercial PCL brace. Objective: To compare posterior tibial translation of applied PCL brace and commercial PCL brace in cadaver with section PCL. Material and Method: This experimental development study conducted in 4 fresh human cadavers (8 knees). All cadaver’s knees with native PCL, section PCL and PCL brace were tested with 150 newton force from telos stress device and measurement of posterior tibial displacement was done under fluoroscope. Results: Posterior tibial translation in native PCL at 30, 60 and 90 degrees are -0.625±09.1, -0.375±0.192 and -1.000±1.31 mm, in section PCL are -8.875±1.81, -7.500±0.32 and -7.625±2.13 mm. In section PCL with commercial PCL brace, posterior tibial translation at 30, 60 and 90 degrees are 4.500±6.28, 3.750±7.17 and 4.500±8.98 mm. Applied PCL brace with section PCL, posterior tibial translation at 30, 60 and 90 degrees 4.75±8.92, 3.375±8.78 and 3.875±11.83 mm. Conclusion: Commercial PCL brace and applied PCL brace can reduce posterior tibial translation in PCL injury groups with statistically significant. Applied PCL brace is not inferior in reduce posterior tibial translation in PCL injury groups when compared with commercial PCL brace. This study is biomechanics study in cadaver, some variable may not include in this study such as hamstring muscle force. PCL brace Hinge knee brace posterior tibial splint dynamic PCL brace posterior cruciate ligament non-operative PCL treatment Figures Figure 1 Figure 2 Figure 3 Introduction Posterior cruciate ligament (PCL) is primary stabilizer in posterior displacement of knee and one of the fourth important ligament of knee. ( 1 ) The incidence of posterior cruciate ligament (PCL) injuries due to accidents varies from 1% to 40% across different population groups selected for study and data collection. ( 2 ) In sports-related accidents, the likelihood of sustaining PCL injury is 58.5% and 71.7% with motorbike accidents ( 2 ) . Diagnosis of PCL injury used clinical and posterior tibial translation (PTT) from stress film (3) . PTT 0–7 mm is grade I PCL injury or partial PCL injury. Isolate complete PCL injury is Grade II PCL injury. PTT of grade II PCL injury is 8–12 mm. In case PTT more than 12 mm is complete PCL injury combined with Posterolateral corner injury or PCL injury grade III (3) . Nonoperative treatment is an option for isolate acute PCL tears (3) . The dynamic force PCL braces is recommended, despite their high cost ( 4 ) . In patients, acute isolated PCL injury that cannot afford dynamic force PCL brace, no specific orthosis was recommended. The applied hinge knee brace was invented by used simple hinge knee brace combined with posterior tibial splint. In this study we used cadaver for experiment efficiency of applied hinge knee brace compared with commercial dynamic PCL brace. Materials and methods Inclusion criteria was cadaver with normal cruciate ligament. Exclusion criteria were (1) cadaveric leg that cannot applied Telos stress device. (2) cadaver with history of trauma or previous surgery at study knee. This study was exemed for ethical approved by the Hospital Ethics Committee. According to the inclusion and exclusion criteria, 4 cadavers (2 male, 2 female), 8 cadaveric knees were included in this study. All procedures are performed by 2 surgeons (J.T. and S.C.). Physical examination for cruciates and collateral ligaments were done. Medial parapatellar incision was done. Cartilage lesion, cruciates ligament condition was recorded. Reference point for marker was identified and metallic marker was fixed. Telos device was applied. PTT was tested in native PCL cadaveric knee with 150-N forces. Portable X-ray was used for record translation of metallic marks. Femoral foot print of PCL was complete resected. Telos device was reapplied.150-N forces from Telos device was applied and X-ray was recorded. Experiment was repeated in 30, 60 and 90 degree of knee flexion angle. Randomized by enveloped was used for order of orthosis, Dynamic(commercial) PCL brace (Ossur rebound), simple hinge knee brace, Applied hinge knee brace. 150-N Telos device was applied on cadaveric knee and portable X-ray was recorded at 30, 60 and 90 degree of knee flexion angle. All of orthosis was used in all cadaveric knee by randomized orthosis order. Reference point identified Standard medial parapatellar approach was done. Subcutaneous soft tissue was dissected at medial side with caution for medial knee structure. Medial epicondyle landmark was palpable. Metallic marker was applied only once for each cadaveric knee. Stability of metallic marker was checked. Proximal tibial insertion of medial collateral ligament (MCL) was identified then metallic marker was applied. Radiographic measurement of posterior tibial translation Telos device was applied to cadaveric knee in lateral position. Goniometer was used for desired angle (30, 60 and 90). Telos device applied anterior to posterior force of 150 N and a lateral knee joint X-ray was taken. The X-ray beam was centered on the joint line. In lateral radiograph, draw first horizontal line parallel with tibial joint line and second vertical line from femoral metallic mark rectangle to first line. The cutting point between first and second line is A point. Third line was draw from tibial metallic mark rectangle to first line. The cutting point between first and second line is B point (Fig.2). Posterior tibial translation is distant from A point to B point. The distant was recorded by PACs software. Orthosis applied Simple hinge knee brace was chosen by cadaveric knee size. Mid-calf circumferential and mid-thigh circumferential was measured. Hinge knee brace was applied in knee flexion position, pivot point of hinge knee brace was applied at center of knee motion. Knee flexion and extension was tested after hinge knee brace was applied. Applied brace, posterior tibial splint was created with 1 inch thick. Length is half of distance between tibial tubercle and most distal landmark of medial malleolus. Posterior tibial splint is applied posterior to tibial tubercle and center of calf. 4-inch elastic bandage was applied, then simple hinge knee brace is applied in previous method. Dynamic PCL brace is applied with highest tension with knee fully extension in each cadaver. Statistical analysis The measurement data are expressed as mean ± standard deviation a P < 0.05 denoted a significant difference. All statistical analyses were performed with SPSS 26.0.0.0. Comparison of data between procedures were assessed by student T test and one-way anova Results 4 cadavers (2 male, 2 female) with 8 knees with mean age 61 ± 6.05 years were exam, good cartilage condition (ICRS 0–1, Outerbridge 0–1) and good tissue quality (no fraying or torn cruciate) of ACL and PCL in all knees. All knee were tested with 150-N force from anterior to posterior direction by Telos stress device. Posterior tibial displacement (Table 1 ) of tested knee in each procedure were shown. Before resected PCL, posterior tibial translation different in each degree of flexion group. After resected PCL, posterior tibial translation increased in all degree of flexion angle. Comparison between native and resected PCL in each group, at 30˚, 60˚, 90˚ shows as order − 0.625 ± 0.91 mm /-8.875 ± 1.81 mm, -0.375 ± 1.92 mm /-7.500 ± 3.16 mm, -1.000 ± 1.31 mm/-7.625 ± 2.13 mm. All degree of flexion groups, posterior tibial translation is increased after PCL was resected with statistically significant different. There are three experiments groups, hinge knee brace group, commercial PCL brace group and applied PCL brace group. Hinge knee brace group shows decrease posterior tibial translation at 30˚ (-6.500 ± 4.28 mm), 60˚ (-6.500 ± 4.28 mm), 90˚ (-6.750 ± 4.50 mm) compared with resected PCL group, but no statistically significant different. Second, commercial PCL brace group shows posterior tibial translation for 4.500 ± 6.28 mm, 3.750 ± 7.17 mm, 4.500 ± 8.98 mm at 30˚, 60˚, 90˚ as order. Comparison outcome between resected PCL group and commercial PCL brace group results in decreased of posterior tibial translation with statistically significant difference. For applied PCL brace, shows statistically significant different in decreased posterior tibial translation compared with resected PCL at 30˚ (4.750 ± 8.92), 60˚ (3.375 ± 8.78), 90˚ (3.875 ± 11.83). Applied PCL brace group shows no statistically significant different posterior tibial translation when compared with commercial PCL brace group in all degree of flexion, but shows statistically significant different when compared with hinge knee brace group. Table 1 posterior tibial translation with PCL status PCL status/degree 30˚ 60˚ 90˚ native -0.625 ± 0.91 -0.375 ± 1.92 -1.000 ± 1.31 resected -8.875 ± 1.81* -7.500 ± 3.16* -7.625 ± 2.13* Data are represented as mean ± SD. Posterior displacement report in millimeter. * Represent statistically significant difference Table 2 Posterior tibial displacement Procedure/degree 30˚ 60˚ 90˚ Hinge knee brace group -6.500 ± 4.28* -6.750 ± 3.54* -6.750 ± 4.50* PCL brace group 4.500 ± 6.28 3.750 ± 7.17 4.500 ± 8.98 Applied brace group 4.750 ± 8.92 3.375 ± 8.78 3.875 ± 11.83 Data are represented as mean ± SD. Posterior displacement report in millimeter. * Represent statistically significant difference Graft 1. Comparison in each group Posterior tibial displacement shows in millimeter. HKB represents Knee experiment with hinge knee brace. PCL represents Knee experiment with PCL brace. APL represents Knee experiment with applied brace. * Represent no statistically significant difference Discussion Currently, orthotic devices come in various forms and have been developed for a variety of purposes, whether it's for injury prevention or post-surgery support. Despite their clinical use in diverse situations, there is still a lack of high-quality research evidence to confirm their effectiveness ( 5 ) . Hewlett et al, categorized orthotic brace in to six categories. PCL brace is one of functional brace. PCL brace exert force to resist the movement of the tibia to posterior and reduce the force acting on PCL ( 6 ) . In 1903, Mayo Robson performed surgery to reconstruction PCL. However, at that time, there were no sufficiently brace devices available to aid in reinforcing stability during treatment and physical therapy ( 7 ) . In 2010, the Albretch Jack PCL Brace, internal spring system with up to 15 points of pressure and constat exert a force between 6 to 7 kilograms throughout knee flexion from 0 to 90˚ ( 6) , was introduced for use in 21 patients with grade 1 and 2 PCL injuries for a period of 4 months. The results showed a reduction in posterior tibial translation to 7.1 millimeters immediatly and 2.3 millimeters at the 12-month. Results shows only 1 patient from 21 patients still had tear PCL on MRI. Jacobi et al, concluded that PCL jack brace can used for non-operative treatment in acute isolated grade 1–2 PCL injury with significantly reduced posterior translation ( 8 ) . Laprad et al, study comparison between the Albrecth Jack PCL brace and the Össur Rebound PCL brace. They utilized three-dimensional motion analysis and a measure intrinsic force in PCL, in standing, knee flexion, squatting and stair climbing position, on healthy individuals who had no previous knee injury. In this study, Albrecth Jack PCL brace exert constant force on the tibial bone regardless of changes in knee flexion angle, unlike the Össur Rebound PCL brace, which increased force on knee flexion angle increased. This increased force from dynamic PCL brace similar to the increased intrinsic force in PCL ( 9 ) . In recent literature review, there are no clinical study of dynamic PCL brace or static PCL brace in PCL injury, only biomechanic studies were found ( 10 – 11 ) . In this study, native PCL was resected to created isolated PCL injury. After resected, posterior tibial translation increased around 5–10 millimeters. Cadaveric with resected PCL similar to grade 1–2 isolated PCL injury, 0–7 millimeters posterior tibial translation is grade 1 PCL injury, 8–11 millimeters posterior tibial translation is grade 2 PCL injury (3,12) . Comparison between hinge knee brace group and resected PCL group show no significant difference in posterior tibial translation. In other group, PCL brace group and applied brace group show reduced in posterior tibial translation in all flexion angle compared with resected PCL group or hinge knee brace group. According to results from many literatures ( 8 – 11 ) , brace with exerted force from posterior tibial can reduced posterior tibial translation, some specific type of brace can increased anterior force to tibia more likely intrinsic force of PCL in increased knee flexion angle. Our study had same results with that literature. Posterior tibial translation in PCL brace group and applied brace group show no statistically difference. Goal of our study to compared applied PCL brace with commercial PCL brace, the results of study shows that applied PCL brace can reduced posterior tibial translation significantly compared with resected PCL group and hinge knee brace group. Especially, applied brace group can reduced posterior tibial translation no significant difference from commercial PCL brace group. Our applied PCL brace has posterior tibial splint that can exerted anterior translation force from posterior tibial, like PCL jack brace with spring mechanism that exerted constant anterior translation force. Literature ( 9 ) that comparison between static PCL brace and dynamic PCL brace reported difference of anterior translation force between two types of brace in many flexion angle, but no reported in posterior tibial translation between these two types of brace. Clinical study in acute isolated PCL injury with PCL brace had only static type PCL brace, PCL Jack brace ( 8 ) . This literature shows good clinical outcomes for non-operative treatment acute isolated PCL injury with static PCL brace. Our study advocate that applied PCL brace, static type, can used in acute isolated PCL injury non inferiorly to dynamic PCL brace. This applied brace suits with low financial patients with limited budget. This study has some limitation. First, the study is cadaveric study. There is no muscle contraction or coupling force when cadaver knee was motion in different flexion angle. There is no antagonist force from hamstring muscle. Second, the position of cadaveric testing is in decubitus position. There is no gravity force related in this study. Last, this study limited in many types of PCL brace, the comparative dynamic PCL brace is only from one company. Conclusion Resected PCL shows posterior tibial translation grade 1-2. Hinge knee brace cannot prevent posterior tibial translation in isolated PCL injury. Commercial dynamic PCL brace can protect posterior tibial translation in isolated PCL. Applied PCL brace shows no inferior results than commercial PCL brace for protected posterior tibial translation in isolated PCL injury. Isolated PCL injury patients with conservative treatment plan, and cannot afford cost of commercial PCL brace, can use applied PCL brace for treatment. Declarations Author Contribution J.T. conceived and designed the study, performed the majority of cadaveric experiments, analyzed and interpreted the data, prepared all figures and tables, and wrote the main manuscript text.S.C. and S.L. assisted with cadaveric testing and data collection.Y.C. contributed to statistical analysis and figure preparation.P.S. participated in literature review and manuscript editing.All authors critically reviewed and approved the final version of the manuscript. Acknowledgement The authors would like to express their deepest gratitude to the donors and the Anatomy Department of Rajavithi Hospital for providing cadaveric specimens for this study. We also thank the staff of the Orthopaedic Department for their technical assistance during the biomechanical experiments. Funding declaration This study did not receive any financial support from any organization, institution, or funding source. References Kakarlapudi TK, Bickerstaff DR. Knee instability—isolated and complex. West J Med. 2001;174(4):266–72. Schlumberger M, Schuster P, Eichinger M, Mayer P, Mayr R, Immendörfer M, et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28(7):2091-8. 3. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018 Jan;6(1):8-18. Schreier FJ, Banovetz MT, Rodriguez AN, LaPrade RF. Cutting-Edge Posterior Cruciate Ligament Reconstruction Principles. Arch Bone Jt Surg. 2021 Nov;9(6):607-617. Kemker BP 3rd, Kankaria R, Patel N, Golladay G. Hip and Knee Bracing: Categorization, Treatment Algorithm, and Systematic Review. J Am Acad Orthop Surg Glob Res Rev. 2021 Jun 7;5(6):e20.00181-12. Hewlett J, Kenney J. Innovations in functional and rehabilitative knee bracing. Ann Transl Med. 2019 Oct;7(Suppl 7):S248. Kennedy JC, Grainger RW. The posterior cruciate ligament. J Trauma. 1967 May;7(3):367-77. Jacobi M, Reischl N, Wahl P, Gautier E, Jakob RP. Acute isolated injury of the posterior cruciate ligament treated by a dynamic anterior drawer brace: a preliminary report. J Bone Joint Surg Br. 2010 Oct;92(10):1381-4. LaPrade RF, Smith SD, Wilson KJ, Wijdicks CA. Quantification of functional brace forces for posterior cruciate ligament injuries on the knee joint: an in vivo investigation. Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):3070-6. Heinrichs CH, Schmoelz W, Mayr R, Keiler A, Schöttle PB, Attal R. Biomechanical evaluation of a novel dynamic posterior cruciate ligament brace. Clin Biomech (Bristol, Avon). 2016 Mar;33:20-25. Welch T, Keller T, Maldonado R, Metzger M, Mohr K, Kvitne R. The effect of a dynamic PCL brace on patellofemoral compartment pressures in PCL-and PCL/PLC-deficient knees. J Exp Orthop. 2017 Dec;4(1):10. LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature. Am J Sports Med. 2015 Dec;43(12):3077-92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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05:01:29","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":42059,"visible":true,"origin":"","legend":"","description":"","filename":"b69c1287357f4a8c98c37c78601c59591structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/e94a9524a4f2a9370d0853f2.xml"},{"id":95529023,"identity":"4e2e8c65-421a-4c57-b544-a89d35d6ef59","added_by":"auto","created_at":"2025-11-10 10:16:42","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49016,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/aa58360c6ef84f3f1e74662b.html"},{"id":95498501,"identity":"f4afd5be-81c0-44d7-8e21-fd1a85b20ac8","added_by":"auto","created_at":"2025-11-10 05:01:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":132781,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eFigure 1 (left)\u003c/u\u003e. Reference point landmark: femoral landmark-medial epicondyle, tibial- proximal insertion of MCL\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFigure 2 (right)\u003c/u\u003e. Radiographic measurement of posterior tibial translation: orange line- draw parallel to tibial joint line, green line – draw from femoral metallic marker rectangular with orange line, red line – draw from tibial metallic marker rectangular with orange line, “A” point is cutting point between green line and orange line, “B” point is cutting point between red line and orange line, posterior tibial translation is distance between point A and B\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/2289bc6c1213d4eb89921924.png"},{"id":95529556,"identity":"48e09aec-b180-41b1-98ee-547c8850d93d","added_by":"auto","created_at":"2025-11-10 10:17:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":216742,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eFigure 3 (left)\u003c/u\u003e. Cadaveric leg with dynamic(commercial) PCL brace (Ossur rebound) on telos device\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFigure 4 (right)\u003c/u\u003e. Cadaveric leg with Applied PCL brace\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/59af717a3f56b5cce63e8b44.png"},{"id":95498502,"identity":"99be2704-0eac-4a93-b6a8-5db851bd2765","added_by":"auto","created_at":"2025-11-10 05:01:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33139,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003eGraft 1. Comparison in each group\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003ePosterior tibial displacement shows in millimeter. HKB represents Knee experiment with hinge knee brace. PCL represents Knee experiment with PCL brace. APL represents Knee experiment with applied brace. * Represent \u003cstrong\u003eno statistically significant difference\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/c1d5dcbc0c3e2e68e74dd04a.png"},{"id":104111903,"identity":"204912bd-e5b8-4598-b471-8be9a060b8e0","added_by":"auto","created_at":"2026-03-07 02:39:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1001783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8007480/v1/6d1f1f3e-271b-4742-981e-106e5391005d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biomechanics comparison of modified posterior tibial splint hinge knee brace and PCL brace in PCL insufficiency: Cadaveric study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePosterior cruciate ligament (PCL) is primary stabilizer in posterior displacement of knee and one of the fourth important ligament of knee. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e The incidence of posterior cruciate ligament (PCL) injuries due to accidents varies from 1% to 40% across different population groups selected for study and data collection. \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e In sports-related accidents, the likelihood of sustaining PCL injury is 58.5% and 71.7% with motorbike accidents \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Diagnosis of PCL injury used clinical and posterior tibial translation (PTT) from stress film \u003csup\u003e(3)\u003c/sup\u003e. PTT 0\u0026ndash;7 mm is grade I PCL injury or partial PCL injury. Isolate complete PCL injury is Grade II PCL injury. PTT of grade II PCL injury is 8\u0026ndash;12 mm. In case PTT more than 12 mm is complete PCL injury combined with Posterolateral corner injury or PCL injury grade III \u003csup\u003e(3)\u003c/sup\u003e. Nonoperative treatment is an option for isolate acute PCL tears \u003csup\u003e(3)\u003c/sup\u003e. The dynamic force PCL braces is recommended, despite their high cost \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e. In patients, acute isolated PCL injury that cannot afford dynamic force PCL brace, no specific orthosis was recommended. The applied hinge knee brace was invented by used simple hinge knee brace combined with posterior tibial splint. In this study we used cadaver for experiment efficiency of applied hinge knee brace compared with commercial dynamic PCL brace.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eInclusion criteria was cadaver with normal cruciate ligament. Exclusion criteria were (1) cadaveric leg that cannot applied Telos stress device. (2) cadaver with history of trauma or previous surgery at study knee. This study was exemed for ethical approved by the Hospital Ethics Committee.\u003c/p\u003e\n\u003cp\u003eAccording to the inclusion and exclusion criteria, 4 cadavers (2 male, 2 female), 8 cadaveric knees were included in this study. All procedures are performed by 2 surgeons (J.T. and S.C.). Physical examination for cruciates and collateral ligaments were done. Medial parapatellar incision was done. Cartilage lesion, cruciates ligament condition was recorded. Reference point for marker was identified and metallic marker was fixed. Telos device was applied. PTT was tested in native PCL cadaveric knee with 150-N forces. Portable X-ray was used for record translation of metallic marks. Femoral foot print of PCL was complete resected. Telos device was reapplied.150-N forces from Telos device was applied and X-ray was recorded. Experiment was repeated in 30, 60 and 90 degree of knee flexion angle. Randomized by enveloped was used for order of orthosis, Dynamic(commercial) PCL brace (Ossur rebound), simple hinge knee brace, Applied hinge knee brace. \u0026nbsp;150-N Telos device was applied on cadaveric knee and portable X-ray was recorded at 30, 60 and 90 degree of knee flexion angle. All of orthosis was used in all cadaveric knee by randomized orthosis order.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReference point identified\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStandard medial parapatellar approach was done. Subcutaneous soft tissue was dissected at medial side with caution for medial knee structure. Medial epicondyle landmark was palpable. Metallic marker was applied only once for each cadaveric knee. Stability of metallic marker was checked. Proximal tibial insertion of medial collateral ligament (MCL) was identified then metallic marker was applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiographic measurement of posterior tibial translation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTelos device was applied to cadaveric knee in lateral position. Goniometer was used for desired angle (30, 60 and 90). Telos device applied anterior to posterior force of 150 N and a lateral knee joint X-ray was taken. The X-ray beam was centered on the joint line. In lateral radiograph, draw first horizontal line parallel with tibial joint line and second vertical line from femoral metallic mark rectangle to first line. The cutting point between first and second line is A point. Third line was draw from tibial metallic mark rectangle to first line. The cutting point between first and second line is B point (Fig.2). Posterior tibial translation is distant from A point to B point. The distant was recorded by PACs software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOrthosis applied\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimple hinge knee brace was chosen by cadaveric knee size. Mid-calf circumferential and mid-thigh circumferential was measured. Hinge knee brace was applied in knee flexion position, pivot point of hinge knee brace was applied at center of knee motion. Knee flexion and extension was tested after hinge knee brace was applied.\u003c/p\u003e\n\u003cp\u003eApplied brace, posterior tibial splint was created with 1 inch thick. Length is half of distance between tibial tubercle and most distal landmark of medial malleolus. Posterior tibial splint is applied posterior to tibial tubercle and center of calf. 4-inch elastic bandage was applied, then simple hinge knee brace is applied in previous method.\u003c/p\u003e\n\u003cp\u003eDynamic PCL brace is applied with highest tension with knee fully extension in each cadaver.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe measurement data are expressed as mean \u0026plusmn; standard deviation a P \u0026lt; 0.05 denoted a significant difference. All statistical analyses were performed with SPSS 26.0.0.0. Comparison of data between procedures were assessed by student T test and one-way anova\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e4 cadavers (2 male, 2 female) with 8 knees with mean age 61\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05 years were exam, good cartilage condition (ICRS 0\u0026ndash;1, Outerbridge 0\u0026ndash;1) and good tissue quality (no fraying or torn cruciate) of ACL and PCL in all knees. All knee were tested with 150-N force from anterior to posterior direction by Telos stress device. Posterior tibial displacement (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) of tested knee in each procedure were shown. Before resected PCL, posterior tibial translation different in each degree of flexion group. After resected PCL, posterior tibial translation increased in all degree of flexion angle. Comparison between native and resected PCL in each group, at 30˚, 60˚, 90˚ shows as order \u0026minus;\u0026thinsp;0.625\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 mm /-8.875\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 mm, -0.375\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92 mm /-7.500\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16 mm, -1.000\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 mm/-7.625\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13 mm. All degree of flexion groups, posterior tibial translation is increased after PCL was resected with statistically significant different. There are three experiments groups, hinge knee brace group, commercial PCL brace group and applied PCL brace group. Hinge knee brace group shows decrease posterior tibial translation at 30˚ (-6.500\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28 mm), 60˚ (-6.500\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28 mm), 90˚ (-6.750\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50 mm) compared with resected PCL group, but no statistically significant different. Second, commercial PCL brace group shows posterior tibial translation for 4.500\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28 mm, 3.750\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17 mm, 4.500\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98 mm at 30˚, 60˚, 90˚ as order. Comparison outcome between resected PCL group and commercial PCL brace group results in decreased of posterior tibial translation with statistically significant difference. For applied PCL brace, shows statistically significant different in decreased posterior tibial translation compared with resected PCL at 30˚ (4.750\u0026thinsp;\u0026plusmn;\u0026thinsp;8.92), 60˚ (3.375\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78), 90˚ (3.875\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83). Applied PCL brace group shows no statistically significant different posterior tibial translation when compared with commercial PCL brace group in all degree of flexion, but shows statistically significant different when compared with hinge knee brace group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eposterior tibial translation with PCL status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCL status/degree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30˚\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60˚\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90˚\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003enative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-0.625\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-0.375\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-1.000\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eresected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-8.875\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-7.500\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-7.625\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are represented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Posterior displacement report in millimeter. * Represent statistically significant difference\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePosterior tibial displacement\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProcedure/degree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30˚\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60˚\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90˚\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHinge knee brace group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-6.500\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-6.750\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-6.750\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCL brace group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.500\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.750\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.500\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApplied brace group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.750\u0026thinsp;\u0026plusmn;\u0026thinsp;8.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.375\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.875\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are represented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Posterior displacement report in millimeter. * Represent statistically significant difference\u003c/p\u003e\n\u003ch3\u003eGraft 1. Comparison in each group\u003c/h3\u003e\n\u003cp\u003e\u003c/p\u003e\u003cp\u003ePosterior tibial displacement shows in millimeter. HKB represents Knee experiment with hinge knee brace. PCL represents Knee experiment with PCL brace. APL represents Knee experiment with applied brace. * Represent \u003cb\u003eno statistically significant difference\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, orthotic devices come in various forms and have been developed for a variety of purposes, whether it's for injury prevention or post-surgery support. Despite their clinical use in diverse situations, there is still a lack of high-quality research evidence to confirm their effectiveness \u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. Hewlett et al, categorized orthotic brace in to six categories. PCL brace is one of functional brace. PCL brace exert force to resist the movement of the tibia to posterior and reduce the force acting on PCL \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn 1903, Mayo Robson performed surgery to reconstruction PCL. However, at that time, there were no sufficiently brace devices available to aid in reinforcing stability during treatment and physical therapy \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. In 2010, the Albretch Jack PCL Brace, internal spring system with up to 15 points of pressure and constat exert a force between 6 to 7 kilograms throughout knee flexion from 0 to 90˚ \u003csup\u003e( 6)\u003c/sup\u003e, was introduced for use in 21 patients with grade 1 and 2 PCL injuries for a period of 4 months. The results showed a reduction in posterior tibial translation to 7.1 millimeters immediatly and 2.3 millimeters at the 12-month. Results shows only 1 patient from 21 patients still had tear PCL on MRI. Jacobi et al, concluded that PCL jack brace can used for non-operative treatment in acute isolated grade 1\u0026ndash;2 PCL injury with significantly reduced posterior translation \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Laprad et al, study comparison between the Albrecth Jack PCL brace and the \u0026Ouml;ssur Rebound PCL brace. They utilized three-dimensional motion analysis and a measure intrinsic force in PCL, in standing, knee flexion, squatting and stair climbing position, on healthy individuals who had no previous knee injury. In this study, Albrecth Jack PCL brace exert constant force on the tibial bone regardless of changes in knee flexion angle, unlike the \u0026Ouml;ssur Rebound PCL brace, which increased force on knee flexion angle increased. This increased force from dynamic PCL brace similar to the increased intrinsic force in PCL \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. In recent literature review, there are no clinical study of dynamic PCL brace or static PCL brace in PCL injury, only biomechanic studies were found \u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn this study, native PCL was resected to created isolated PCL injury. After resected, posterior tibial translation increased around 5\u0026ndash;10 millimeters. Cadaveric with resected PCL similar to grade 1\u0026ndash;2 isolated PCL injury, 0\u0026ndash;7 millimeters posterior tibial translation is grade 1 PCL injury, 8\u0026ndash;11 millimeters posterior tibial translation is grade 2 PCL injury \u003csup\u003e(3,12)\u003c/sup\u003e. Comparison between hinge knee brace group and resected PCL group show no significant difference in posterior tibial translation. In other group, PCL brace group and applied brace group show reduced in posterior tibial translation in all flexion angle compared with resected PCL group or hinge knee brace group. According to results from many literatures \u003csup\u003e(\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e, brace with exerted force from posterior tibial can reduced posterior tibial translation, some specific type of brace can increased anterior force to tibia more likely intrinsic force of PCL in increased knee flexion angle. Our study had same results with that literature. Posterior tibial translation in PCL brace group and applied brace group show no statistically difference. Goal of our study to compared applied PCL brace with commercial PCL brace, the results of study shows that applied PCL brace can reduced posterior tibial translation significantly compared with resected PCL group and hinge knee brace group. Especially, applied brace group can reduced posterior tibial translation no significant difference from commercial PCL brace group. Our applied PCL brace has posterior tibial splint that can exerted anterior translation force from posterior tibial, like PCL jack brace with spring mechanism that exerted constant anterior translation force. Literature \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e that comparison between static PCL brace and dynamic PCL brace reported difference of anterior translation force between two types of brace in many flexion angle, but no reported in posterior tibial translation between these two types of brace. Clinical study in acute isolated PCL injury with PCL brace had only static type PCL brace, PCL Jack brace \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. This literature shows good clinical outcomes for non-operative treatment acute isolated PCL injury with static PCL brace. Our study advocate that applied PCL brace, static type, can used in acute isolated PCL injury non inferiorly to dynamic PCL brace. This applied brace suits with low financial patients with limited budget.\u003c/p\u003e\u003cp\u003eThis study has some limitation. First, the study is cadaveric study. There is no muscle contraction or coupling force when cadaver knee was motion in different flexion angle. There is no antagonist force from hamstring muscle. Second, the position of cadaveric testing is in decubitus position. There is no gravity force related in this study. Last, this study limited in many types of PCL brace, the comparative dynamic PCL brace is only from one company.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eResected PCL shows posterior tibial translation grade 1-2. Hinge knee brace cannot prevent posterior tibial translation in isolated PCL injury. Commercial dynamic PCL brace can protect posterior tibial translation in isolated PCL. Applied PCL brace shows no inferior results than commercial PCL brace for protected posterior tibial translation in isolated PCL injury. Isolated PCL injury patients with conservative treatment plan, and cannot afford cost of commercial PCL brace, can use applied PCL brace for treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eJ.T. conceived and designed the study, performed the majority of cadaveric experiments, analyzed and interpreted the data, prepared all figures and tables, and wrote the main manuscript text.S.C. and S.L. assisted with cadaveric testing and data collection.Y.C. contributed to statistical analysis and figure preparation.P.S. participated in literature review and manuscript editing.All authors critically reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to express their deepest gratitude to the donors and the Anatomy Department of Rajavithi Hospital for providing cadaveric specimens for this study. We also thank the staff of the Orthopaedic Department for their technical assistance during the biomechanical experiments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edeclaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any financial support from any organization, institution, or funding source.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKakarlapudi TK, Bickerstaff DR. Knee instability\u0026mdash;isolated and complex. West J Med. 2001;174(4):266\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eSchlumberger M, Schuster P, Eichinger M, Mayer P, Mayr R, Immend\u0026ouml;rfer M, et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28(7):2091-8. 3. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018 Jan;6(1):8-18. \u003c/li\u003e\n\u003cli\u003eSchreier FJ, Banovetz MT, Rodriguez AN, LaPrade RF. Cutting-Edge Posterior Cruciate Ligament Reconstruction Principles. Arch Bone Jt Surg. 2021 Nov;9(6):607-617. \u003c/li\u003e\n\u003cli\u003eKemker BP 3rd, Kankaria R, Patel N, Golladay G. Hip and Knee Bracing: Categorization, Treatment Algorithm, and Systematic Review. J Am Acad Orthop Surg Glob Res Rev. 2021 Jun 7;5(6):e20.00181-12. \u003c/li\u003e\n\u003cli\u003eHewlett J, Kenney J. Innovations in functional and rehabilitative knee bracing. Ann Transl Med. 2019 Oct;7(Suppl 7):S248. \u003c/li\u003e\n\u003cli\u003eKennedy JC, Grainger RW. The posterior cruciate ligament. J Trauma. 1967 May;7(3):367-77. \u003c/li\u003e\n\u003cli\u003eJacobi M, Reischl N, Wahl P, Gautier E, Jakob RP. Acute isolated injury of the posterior cruciate ligament treated by a dynamic anterior drawer brace: a preliminary report. J Bone Joint Surg Br. 2010 Oct;92(10):1381-4. \u003c/li\u003e\n\u003cli\u003eLaPrade RF, Smith SD, Wilson KJ, Wijdicks CA. Quantification of functional brace forces for posterior cruciate ligament injuries on the knee joint: an in vivo investigation. Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):3070-6. \u003c/li\u003e\n\u003cli\u003eHeinrichs CH, Schmoelz W, Mayr R, Keiler A, Sch\u0026ouml;ttle PB, Attal R. Biomechanical evaluation of a novel dynamic posterior cruciate ligament brace. Clin Biomech (Bristol, Avon). 2016 Mar;33:20-25. \u003c/li\u003e\n\u003cli\u003eWelch T, Keller T, Maldonado R, Metzger M, Mohr K, Kvitne R. The effect of a dynamic PCL brace on patellofemoral compartment pressures in PCL-and PCL/PLC-deficient knees. J Exp Orthop. 2017 Dec;4(1):10. \u003c/li\u003e\n\u003cli\u003eLaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature. Am J Sports Med. 2015 Dec;43(12):3077-92. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PCL brace, Hinge knee brace, posterior tibial splint, dynamic PCL brace, posterior cruciate ligament, non-operative PCL treatment","lastPublishedDoi":"10.21203/rs.3.rs-8007480/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8007480/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePosterior cruciate ligament (PCL) is an intra-articular structure. Non-operative treatment with PCL brace is mainstay treatment for acute isolated PCL injury. Commercial PCL brace typically cost expensive. We developed an applied PCL brace for substituted commercial PCL brace.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo compare posterior tibial translation of applied PCL brace and commercial PCL brace in cadaver with section PCL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Method: \u003c/strong\u003eThis experimental development study conducted in 4 fresh human cadavers (8 knees). All cadaver’s knees with native PCL, section PCL and PCL brace were tested with 150 newton force from telos stress device and measurement of posterior tibial displacement was done under fluoroscope.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ePosterior tibial translation in native PCL at 30, 60 and 90 degrees are -0.625±09.1, -0.375±0.192 and -1.000±1.31 mm, in section PCL are -8.875±1.81, -7.500±0.32 and -7.625±2.13 mm. In section PCL with commercial PCL brace, posterior tibial translation at 30, 60 and 90 degrees are 4.500±6.28, 3.750±7.17 and 4.500±8.98 mm. Applied PCL brace with section PCL, posterior tibial translation at 30, 60 and 90 degrees 4.75±8.92, 3.375±8.78 and 3.875±11.83 mm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCommercial PCL brace and applied PCL brace can reduce posterior tibial translation in PCL injury groups with statistically significant. Applied PCL brace is not inferior in reduce posterior tibial translation in PCL injury groups when compared with commercial PCL brace. This study is biomechanics study in cadaver, some variable may not include in this study such as hamstring muscle force.\u003c/p\u003e","manuscriptTitle":"Biomechanics comparison of modified posterior tibial splint hinge knee brace and PCL brace in PCL insufficiency: Cadaveric study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:01:24","doi":"10.21203/rs.3.rs-8007480/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd359513-f96a-4ef2-8644-d4b8325b8f93","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-07T02:39:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 05:01:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8007480","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8007480","identity":"rs-8007480","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}