The knee brace is as integral a piece of equipment as shoulder pads for NLL players who have had knee injuries.

It’s nothing new, of course.

John Grant Jr. twice had reconstructive surgery on his left knee and missed the entire 2009 season after surgery to combat an infection. The NLL’s No. 2 all-time scorer had arthroscopic surgery on his right knee on Sept. 8, 2016, and after being slowed by other injuries, was limited to a cameo appearance with the Colorado Mammoth last season before announcing his retirement. The heart was willing but the body balked.

Former MVP finalist Garrett Billings blew a knee out cutting to the net late in Toronto’s 2014 season and after two trades, his lacrosse career is in limbo. He’s currently serving a probation period towards becoming a firefighter.

What is downright frightening is the recent rash of knee injuries. It seems that the majority of victims are forwards, making quick changes in direction to get past checkers for a plum shooting position in front of the net.

“ACL tears occur with a sudden change in direction or pivot against a locked knee or a sudden deceleration,” said Rochester Knighthawks athletic therapist Stephen Lobsinger. “ACL injuries are often associated with meniscal tears and bruising of the articular surface of the femur. It’s not uncommon for athletes to hear an audible pop associated with tearing the ACL.”

While it is impossible to prevent against contact-related ACL injuries, “we can however prevent against non-contact injuries by improving hamstring strength and doing more deceleration training,” Lobsinger said.

Cody Jamieson, the 2014 league MVP, played only Rochester’s 2017 NLL opener before a damaged knee ended his season.

The marvels of modern medicine allow some players to come back strong and Jamieson certainly hopes that is the case, as it was with star Vancouver forward Corey Small. Small missed the entire 2014 season while with Edmonton after blowing out a knee, but became an MVP-worthy attacker with the Stealth. Saskatchewan Rush forward Curtis Knight also came back strong after missing the 2015 season with a knee injury.

Leading Toronto scorer Rob Hellyer and Georgia Swarm forward Jesse King sat out the 2017 season while rehabbing from knee injuries suffered playing summer ball. Colorado begins the new season without defensemen Dan Coates and Cam Holding, who both went down with knee injuries during Team Canada tryouts in October, and Vancouver will start the season without defenseman Jon Harnett, who blew out a knee during training camp.

The list of players felled by knee injuries goes on and on.

The Rock has been hit hard. Damon Edwards missed all of 2016 and Scott Johnston, Pat Merrill and Brock Sorensen have been victims. Andrew Suitor, who has tried to extend his career after surgeries on both knees, has been released by Rochester.

Jim Starkey, head athletic trainer for the Buffalo Bandits, said 20 percent of his active roster players used knee braces last season.

“Four active roster players had previously sustained a significant knee injury requiring brace use recommended by the medical staff,” he said.

The main brand used is DonJoy (United States). Mueller (United States) and Ossur (Iceland) also supply knee braces. Most higher-end ones weigh just more than a pound (18-22 ounces), Starkey said.

“They can cost anywhere from $35 for an off-the-shelf hinged knee brace to over $1,000 for a custom carbon fiber knee brace,” Starkey said.

Hellyer tore the ACL in his right knee playing for the Oakville Rock of Ontario’s summer league on June 27, 2016 — a day before his 24th birthday. He had the ball and planted his right foot. The knee buckled. He had surgery at the end of August. He got the go-ahead from doctors the following June to resume his lacrosse career.

“It’s a long process,” he said of rehab. “You’ve got to be patient with it. You’ve got to trust your physio and your doctors. You can’t rush it. You’ve got to let it heal properly. Progress is slow. It’s at least a ninth-month process after surgery to get back playing. You will get back playing but it’s a long process.”

Hellyer does more pre-game stretching and rolling-out exercises now.

“I’m focusing on maintaining the body more than I used to,” he said.

He will wear a custom made DonJoy knee brace this season.

“It was a little uncomfortable at the start,” he said. “Ideally, I’d like to play without one but I have to use it for at least the first year. After that, we’ll see.”

Why have there been so many knee injuries?

“I’m not sure,” Hellyer said. “Getting caught up in the turf is one reason and there’s nothing to do about that unless you want to play on cement. I always thought I had a strong lower body and wouldn’t have to deal with this. It’s basically freak accidents. You see it a lot in football, too. It just happens.’’

Now he just wants to score goals.

“I’m extremely excited,” he said of his return. “It was a long year being away and watching from the press box. It wasn’t easy. But, basically, I’m 100 percent now. It’s just a matter of getting the rust off. I’m very excited to get going.”

King is wearing a custom-made Ossur brace on the left knee he hurt on Aug. 17, 2016, playing for the Victoria Shamrocks in British Columbia’s summer league. He was on a breakaway, faked far side, planted the leg and came back short side, and the knee kept going the other way.

“I knew right away something was not good,” he said.

Surgery was Oct. 24, 2016. He was not cleared to resume playing until the end of September because of the nature of the repairs. A tendon was taken from a hamstring and used as a new ACL.

Recovery was a long 11 months plus.

“I’m still working on my strength,” he said. “The physio process was pretty good because I’m okay with working hard and pushing myself. I took it as a challenge. The physical side of things I found got easier when I worked with a physiotherapist. But the mental part is more difficult than people realize. I’m sitting there on a couch on a Saturday night watching my team play when I want to be out there.’’

He worried at first that the injury might influence the way he plays but that hasn’t been the case.

“I thought it was going to have more of an impact,” he said. “With the knee brace on, I’m confident. I’m not thinking not to take that extra step because of the knee. I’m getting used to the brace. I wear a little sleeve under it so it’s not irritating my skin.”

Like Hellyer, he’ll re-evaluate at season’s end the need to wear a brace. He can’t wait to get into a game with the Swarm.

“It’s unmeasured,” he said when asked to explain getting back into the fray. “I think we’ll be right back up there again.”

NLL players are more fit and powerful today than ever and they try lateral moves that push knees to their limits, and that can lead to knee injuries.

Playing surfaces might be another factor in knee injuries among players involved with multiple teams each year. Green NLL carpets become cement for some summer teams and cleats are often used to play field lacrosse. The legs adjust to one floor and, all of a sudden, they are making the same moves on a completely different surface.

“The road to recovery is a long and arduous one,” Lobsinger said. “It also is one that should not be rushed. Muscular testing to evaluate the ratio of quadriceps to hamstring strength and comparing those results with the unaffected side are good indicators of preparedness.”