1. 20.50 Only OTS Solution
to Patellofemoral Pain
Vague anterior knee pain is a very common patient complaint. It affects some 2.5
million Americans annually and is one of the largest and most challenging complaints
physicians hear. Patellofemoral Pain Syndrome is now recognized to encompass a
large disparate group of medical conditions that cause pain at the front of the knee.
The patient profile is predominantly weighted women and young girls. The insurance
trend is moving towards off-the-shelf bracing.
Form Follows Flexion
The most common bracing solution to anterior knee pain is a
soft sleeve. These use one of several buttress designs to put
pressure on the patella. As the leg goes into extension, these
buttresses exert pressure to keep the patella in the patellar
groove. But patients are experiencing insufficient relief from
the soft braces. Soft Braces do not provide the lateral strength
to resist the quad. Hinged soft knee braces provide greater lateral strength, but still not
sufficient to resist the muscle group with patellofemoral problems. The biggest issue is
the disrupted movement of the patella gliding into the femoral groove. In normal
patellofemoral articulation, the patella is in contact with the femur between 20 and 50
degrees flexion.
As the only patellofemoral brace functioning at 20 – 50 degrees flexion, the 20.50
Patellofemoral Brace:
 Improves patellofemoral tracking
 Controls patellar subluxation and dislocation
Traditional soft sleeve braces have little impact on the patella at the point in time where
they could alter the tracking. Additionally, the brace must be rigid enough to act as a
strong, stable foundation to counter the lateral force of the quadriceps. This requires a
rigid brace and dynamic action that adapts to the increasing pressure. The rigid shell
performance of the 20.50 Patellofemoral Brace counters the force of the quads and
resists rotation.
Bledsoe is the only manufacturer making a rigid frame
off-the-shelf patellofemoral brace that functions in flexion.
This is a doubly nice distinction for us as it is the only off-the-shelf brace on the market
and an off-the-shelf brace can be stock and bill while a custom brace cannot. Our
competitor’s are offering only custom rigid frames.
Page 1 of 7

2. Defining the Pain
Patellofemoral pain syndrome can be defined as retropatellar or peripatellar pain
resulting from physical and biochemical changes in the patellofemoral joint. It should
be distinguished from chondromalacia, which is actual fraying and damage to the
underlying patellar cartilage. Patients with patellofemoral pain syndrome have anterior
knee pain that typically occurs with activity and often worsens when they are
descending steps or hills. It can also be triggered by prolonged sitting. One or both
knees can be affected.
The patella (kneecap) is the moveable bone on the front of the knee. The patella
articulates with the patellofemoral groove in the femur. Several forces act on the
patella to provide stability and keep it tracking properly.
This unique bone is wrapped inside a tendon
that connects the large muscles on the front of
the thigh, the quadriceps muscles, to the lower
leg bone. The large quadriceps tendon together
with the patella is called the quadriceps
mechanism. Though we think of it as a single
device, the quadriceps mechanism has two
separate tendons, the quadriceps tendon on top
of the patella and the patellar tendon below the patella.
Tightening up the quadriceps muscles places a pull on the tendons of the quadriceps
mechanism. This action causes the knee to
straighten. The patella acts like a fulcrum to
increase the force of the quadriceps muscles.
The underside of the patella is covered with
articular cartilage, the smooth, slippery covering
found on joint surfaces. This covering helps the
patella glide (or track) in a special groove made by
the thighbone, or femur. This groove is called the
femoral groove.
Two muscles of the thigh attach to the patella and
help control its position in the femoral groove as
the leg straightens. These muscles are the Vastus
Medialis Obliquus (VMO) and the Vastus Lateralis
(VL). The VMO runs along the inside of the thigh,
and the VL lies along the outside of the thigh. If the
timing between these two muscles is off, the patella
may be pulled off track.
Page 2 of 7

3. A common misconception is that the patella only moves in an up-and-down direction.
In fact, it also tilts and rotates, so there are various points of contact between the
undersurface of the patella and the femur.
Causes of Patellofemoral Pain Syndrome
Managing patellofemoral pain syndrome is a challenge, in part because of lack of
consensus regarding its cause and treatment.
Overuse and overload of the patellofemoral joint
Because bending the knee increases the pressure between the patella and its various
points of contact with the femur, patellofemoral pain syndrome is often classified as an
overuse injury. However, a more appropriate term may be "overload," because the
syndrome can also affect inactive patients. Repeated weight-bearing impact may be a
contributing factor, particularly in runners. Steps, hills and uneven surfaces tend to
exacerbate patellofemoral pain. Once the syndrome has developed, even prolonged
sitting can be painful ("movie-goer's sign") because of the extra pressure between the
patella and the femur during knee flexion.
Biomechanical Problems
Pes Planus (Pronation). The
terms "flat feet" and "foot
pronation" are often used
interchangeably. Technically
speaking, foot pronation is a
combination of eversion,
dorsiflexion and abduction of the
foot. This condition often occurs
in patients who lack a supportive Pes planus, or flat foot (left), in a nonweight-bearing state.
medial arch. Foot pronation Loss of the medial arch with weight-bearing (right) causes
the ankle to "roll" medially. To compensate, the femur or
causes a compensatory internal tibia rotates internally, increasing valgus and stressing the
rotation of the tibia or femur patellofemoral mechanism. Arch supports can help with
(femoral anteversion) that upsets this problem.
the patellofemoral mechanism. This is the premise behind
using arch supports or custom orthotics in patients with
patellofemoral pain.
Pes Cavus (High-Arched Foot, Supination). Compared with
a normal foot, a high-arched foot provides less cushioning
for the leg when it strikes the ground. This places more
stress on the patellofemoral mechanism, particularly when a
person is running. Proper footwear, such as running shoes
with extra cushioning and an arch support can be helpful.
Q Angle. Although some investigators believe that a "large"
Q angle is a predisposing factor for patellofemoral pain,
Q angle. The relevance of this
measurement in patients with
Page 3 of 7 patellofemoral pain syndrome
has been questioned.

4. others question this claim. One study found similar Q angles in symptomatic and non-
symptomatic patients.
Another study compared the symptomatic and asymptomatic legs in 40 patients with
unilateral symptoms and found similar Q angles in each leg. Furthermore, "normal" Q
angles vary from 10 to 22 degrees, depending on the study, and measurements of the Q
angle in the same patient vary from physician to physician. Therefore, the physician
should be wary of placing too much emphasis on such biomechanical "variants," as this
can lead patients to believe that nothing can be done about their pain.
Muscular dysfunction
Weakness of the quadriceps muscles is the most often cited area of concern. Other
issues include a muscle imbalance where the quadriceps actually pull the patella out of
the patellar groove, weak quadriceps, hip muscles, calf muscles, hamstrings, or tight
iliotibial bands.
Symptoms
Slipping Sensation
When people have patellofemoral problems, they sometimes report a sensation like the
patella is slipping.
Pain
Others report having pain around the front part of the knee or along the edges of the
kneecap. Typically, people who have patellofemoral problems experience pain when
walking down stairs or hills. Keeping the knee bent for long periods, as in sitting in a
car or movie theater, may cause pain.
“Popcorn”
The knee may grind, or there may be a crunching sound when squatting or going up
and down stairs.
Page 4 of 7

5. Treatment Options
Non-surgical Treatment
The initial treatment for a patellar problem begins by:
 Decreasing the inflammation in the knee
 Rest and anti-inflammatory medications
 Physical therapy, possibly with ice massage and ultrasound to limit pain
and swelling
 Bracing or taping the patella to prevent mal-tracking
Surgical Treatment
If non-surgical treatments fail to improve the condition, surgery may be suggested.
Lateral Release
The doctor will cut little slits in the lateral muscles to decrease the lateral pull.
Proximal Realighment
The doctor will advance the Vastus Medialus Oblique (VMO) muscle over the
patella to increase the medial pull.
Distal Realignment
The doctor will detach the Patella Tuberosity (connecting part for the quad
muscle and reattach the bone in an area they think will correct the Q angle.
Sometimes the doctor will do all three at once.
Page 5 of 7

6. The 20.50 Patellofemoral brace offers several innovations:
 First rigid off-the-shelf patellofemoral brace
on the market
 Patello-Force™ strap promotes natural patella
movement including tilt and rotation
 Magnesium frame adds stable foundation for
Patellofemoral as well as MCL and LCL support
 Shortest brace in this market
 Made of high strength magnesium alloy and
weighs a mere 12 -13 ounces
 Crescent Finger™ Pad grips the patella to
control Medial Tilt, Patellar Baja and other
forces
 Corrects high Q-Angle lateral pull
The strapping has a unique look and function to:
 Effectively control mal-tracking
 Counter high Q-angle pull
 Allow appropriate movement on the knee including tilt and rotation
Due to the short frame, the brace sits above the calf muscle belly, unlike other braces in this
market. Therefore, the tibial shell is one size smaller than the femoral shell in the standard
black off-the-shelf version. The 20.50 is also available in a custom version.
Off-the-Shelf price is $ 399 Custom price is $ 599
Lcode: L1845 Lcode: L1846
Satisfies patella tracking add-on code L2800 (Custom) or L2795 (OTS).
Size Thigh Calf Left Right
34.3 – 40.6 cm 27.9 – 31.7 cm
XS PF010101 PF010201
13.5” -16.0” 11.0” – 12.5”
40.6 – 47.6 cm 31.7 – 35.6 cm
S PF010103 PF010203
16.0” – 18.75” 12.5” – 14.0”
47.6 – 54.6 cm 35.6 – 39.4 cm
M PF010105 PF010205
18.75” – 21.5” 14.0” – 15.5”
54.6 – 61.6 cm 39.4 – 43.2 cm
L PF010107 PF010207
21.5” – 24.25” 15.5” – 17.0”
61.6 – 68.6 cm 43.2 – 47.0 cm
XL PF010109 PF010209
24.25” – 27.0” 17.0” – 18.5”
68.6 – 74.9 cm 47.0 – 50.8 cm
XXL PF010111 PF010211
27.0” – 29.5” 18.5” – 20.0”
Page 6 of 7

7. Accessories
The replacement pad kit consists of:
 Femoral pad
 Tibial pad
 Regular strap pad
 Gripper strap pad
 Y-patella pad and air bladder (no pump)
 Patella buttress pad
Size Left Right
XS PF040101 PF040201
S PF040103 PF040203
The replacement strap
M PF040105 PF040205 kit consists of the two
L PF040107 PF040207 regular straps and the
XL PF040109 PF040209 two elastic straps. The
XXL PF040111 PF040211 part numbers are:
Size Left
XS PF041001
S PF041003
M PF041005
L PF041007
XL PF041009
XXL PF041011
Page 7 of 7