After he lost his right leg in a car accident, Brian Bartlett was told he'd have to give up extreme sports – so he set out to prove the experts wrong.
When Brian Bartlett was 24 he was hit by a car from behind so hard it ripped his right leg off. It all happened so fast. He doesn’t like to talk about it. “You really can’t understand,” he told me. “There’s just no way to… until you have an injury where you’re ripped or cut apart instantly.”
He turned 25 in hospital. When he left, fitted above the knee with a prosthetic leg, he wanted to return to his life. Before the accident, Bartlett had been a competitive skier, on track for the US Olympic team. So after the accident, he was eager to get back to the slopes. It was 1998, long before Oscar Pistorius would take the track at the Olympics. When he asked his prosthetist about getting back into skis, he wasn’t ready for what he heard. He was told he wouldn’t ski again, not the way he had before.
The best way to get Bartlett to do something is to tell him that he can’t. Within a year of the accident, he was back on the slopes, skiing with disabled ski teams. In his first year he made it to the International Paralympic Committee’s Alpine Skiing World Cup, and came in seventh in the world. But it wasn’t enough. “It just didn’t fill the need,” he says. “It’s not that I didn’t like the disabled sports, it just wasn’t like it used to be.”
So, he decided to invent a new kind of knee. The Bartlett Tendon Universal Knee, or BTK, has been featured in museums and called a “pioneering development” in prosthetic technology. But for Bartlett, all that mattered was whether he could get back on the slopes.
Standard prosthetic legs can be uncomfortable and unsuited to extreme sports (Credit: Getty Images)
Around 2001, everyone told Bartlett that what he wanted didn’t exist. That it couldn’t exist. That he was so unusual that there was simply no market for what he wanted. “You’re one half of 1%,” they told him.
This moment – when an amputee realises that the arms or legs or hands that they’re being offered simply aren’t acceptable – repeats throughout history. It’s also where many of the biggest advances in prosthetic technology have come from.
On 1 June 1861, James E Hanger enrolled in the Confederate Army. He was 18 and had just dropped out of engineering school at Washington College to join the fight. The very next day, in a skirmish against Union troops, a cannonball tore through his left leg. Hanger was quite possibly the first wounded veteran of the American Civil War. By the end of the war four years later, there were 60,000 amputees.
The Hanger leg was one of the first prosthetics
Hanger returned home with a peg leg he hated – and so he spent the next decade producing something better. Looking less like a peg leg and more like a medieval knight’s armour, the Hanger leg had joints at both the knee and the ankle, and included rubber pads to buffer the noise of the contraption. Today, Hanger Prosthetics and Orthotics is one of the largest prosthetics manufacturers in the USA. In 2013 they reported more than $1bn (£650m) in sales.
Hanger might be the most famous example, but he’s not the only one. Bob Radocy, like Bartlett, was a skier before he lost his hand. But the prosthetic hands out there couldn’t hold onto the ski poles well enough. “I didn’t have technology to meet my needs to do what I wanted to do; I felt like I was being limited by the technology,” he says. So he built his own. Radocy spent months researching patents for hands all the way back to the 1800s. By 1979 he had a hand that he liked, that could grasp his poles. Today, he still skis using his own designs.
But what Bartlett needed was a knee.
About 15 years ago, Bartlett decided he had to get away from skiing competitions. He wanted to find himself, he says, to figure out what his life was going to be like. So he got a trucking licence, for the same reason he does most things: “because people told me I couldn’t do it with the prosthetic”. Bartlett had his prosthetist work with him to design a special knee brace for his prosthetic knee, to keep it in place and help him shift gears.
(Credit: istock)
During his trucking days, Bartlett’s knee was cobbled together from parts that the University of Washington had given him. He’d spent time volunteering with students there, in exchange for parts, as they practiced evaluating and fitting amputees. Across the front he strapped a piece of rubber, to simulate a knee’s natural bounce. At the time, he was experimenting with different thicknesses for that rubber, glueing strips of laminate together to see which version worked best.
Bartlett drove his trucks hard and fast, so he could get ahead of schedule and spend time mountain biking on his test leg. That was the routine: drive, bike, drive. “I was burning the candle at both ends, so I could test out the prototype and stay on schedule and make money.”
After a year of trucking he returned home to Washington. He’d realised he needed to know more about prostheses before he could really make his own, so he convinced FabTech – the company his prosthetist worked with – to hire him part-time, building devices.
Bartlett is the first to admit that this relationship was rocky: “They wanted to fire me. They didn’t even like me,” he says. He would do the work they asked, and then stay late, using their tools and materials to test out his own ideas. “I wasn’t the best employee because I was trying to use their parts to make my stuff.”
(Credit: Getty Images)
Greg Mattson, the CEO of FabTech, was his boss at the time. They’re now business partners. “Here’s what I know about Brian,” says Mattson. “He’ll show up, he’ll grab a pen and he’ll sketch it out on a piece of paper, and he’ll take that and say ‘Here’s what I want to do’. He’s that mad scientist.”
Bartlett paints it another way. “He thought I was crazy, which is probably easy to do.”
At some point Bartlett quit FabTech. And at some point – neither he nor Mattson remembers precisely when – came the change that was key to BTK’s evolution: tendons.
Prosthetic or not, knees are essentially hinges. In a biological knee, the hinge is flanked by tendons that help it bend and move and snap back into place. These provide tension; when you push against them, they stretch, and when you stop pushing they pull the knee back into place. Prosthetic knees, especially active ones, are often supplemented with springs or shock absorbers to cushion impact. But they don’t provide natural tension. “If you were standing right now and you bent your knee, most prosthetic knees would struggle to help you come back up and you’d have to use your able-bodied leg to go straight again,” explains Jeff Erenstone, a prosthetist based in upstate New York who works with a lot of adaptive athletes. Of Bartlett’s knee, he says the tendons are “more effective at giving you the power to straighten out your leg again”.
Prosthetics for runners have come a long way since the early "pre-blade" days (Credit: Getty Images)
The first time I met Bartlett in person was in Breckenridge, Colorado. He had invited me to come see him at The Hartford Ski Spectacular, an event for disabled skiers and snowboarders. We had no plans for when, or where, to meet. “Just call when you’re on the mountain,” he said.
I worried that I’d fly to Colorado and never actually get to meet him, but in the hallway among a sea of disabled skiers and teachers, we finally connected. “I’m about to go fit a guy with the knee, but I’m not sure I want you to watch,” he told me.
Chris Canfield is a difficult customer, Bartlett said. Canfield is himself an athlete; he bikes up and down mountains all around Colorado. He had biked to the event that day. He’d known Bartlett for years, but uses a classic knee (Bartlett called it an “old-school hinge”). Canfield was sceptical of anything fancy. How much better could it really be?
Within minutes, Canfield was fitted with a tendon knee. Bartlett even popped the tendons off his own knee to give to Canfield, so he could try it with some rubber that was already broken in. Soon, Canfield was riding his mountain bike up and down the hotel hallway.
“Try standing,” Bartlett said. Canfield stood on his pedals and grinned. He had never stood on his bike before. While Bartlett tried to make fine adjustments to the knee, rotating the cams on the outside that control how tightly the tendons pull, Canfield wasn’t listening. He wanted to get outside and really ride. “Just make sure you bring it back,” Bartlett said, laughing. Canfield was already out the door.
See Bartlett’s device up close, in the first minute of this technical video about assembly and adjustment
Bartlett’s rubber tendons flank the hinge and provide natural-feeling resistance and tension for the user. When he first started trying the tendons, he welded metal tabs to his socket – the part that hugs the stump of his leg – and ran the rubber tendons through those tabs to keep them in place. Today, two rotating cams on either side of the knee help the user dial into exactly how much resistance they want for the task they’re doing. The tendons can be replaced easily, as can the shock absorber – this is designed for a man going off 12-metre jumps, after all.
There are trade-offs, though. Erenstone told me that although he hasn’t fitted an amputee with a Bartlett knee, he has serviced them before, which has allowed him insight into what they can and can’t do. “His tendons are ginormous,” Erenstone says, which means the knee isn’t good for every extreme sport. “It’s heavy, it’s bulky,” he says. Erenstone wouldn’t recommend it for rock climbing, and “for biking cross-country – in other words, going up hills – you have to overpower the tendons to do that, so it’s inefficient.” But for alpine skiing or downhill mountain biking, in his opinion, it’s an “excellent design”.
A skier rides downhill on the Bartlett knee, recording with a selfie stick
Nicole Roundy, a Paralympic snowboarder, says what many say about the BTK: it just feels more natural. “You can really ride those tendons…rather than getting a kickback,” she told me. She’s the first above-the-knee amputee to compete in adaptive snowboarding, and in the 2014 Winter Paralympics she came in eighth in the snowboard cross, riding on Bartlett’s knee.
Long before Roundy was racing on the knee, it was Bartlett once again speeding down hills on it. At some point, between working at FabTech and heading into the hills with his truck, Bartlett got really good at mountain biking. This new kind of racing filled the need that skiing once did – the adrenaline, the competition, the thrill of hurtling down a mountain. Before the accident, Bartlett’s skiing had been sponsored by Red Bull, so he got in touch. Soon they were sponsoring him as a cyclist.
Since there’s no mountain biking circuit for disabled people, Bartlett was competing once again with able-bodied athletes – only this time with two legs, one a prototype tendon knee. And he was winning. People started noticing.
Bartlett rides through a forest on his mountain bike - fast
Many of the people now fitted with the BTK heard about it by word of mouth. Here was an amputee, holding his own against the best downhill mountain bikers in the world, wearing this weird-looking prosthetic leg he’d built himself. People would ask where they could get one, if he could make them one. He always said no. The knee had never been designed for other people to use.
Bartlett still constructs all his knees by hand – “my hands are like the quality control” – but he doesn’t always have control over how well certain pieces are manufactured. He tests every prototype himself, so nobody else gets hurt if something breaks. “I didn’t want anybody to try it,” he says. “It was too dangerous.” In the early days he had another fear, too: “I was worried that maybe it was a placebo. That it was all in my head.”
He finally caved for a friend, who wanted to get back on a mountain bike again. “He ripped, he still rips today,” says Bartlett. The feeling of seeing someone using his knee was one he hadn’t anticipated: it was a new high.
Then in 2007, Bartlett got a call from the Walter Reed National Military Medical Center – he remembers the year because in order to get a federal contract, he had to found his company, Left Side, Inc. The US military wanted to test his knee on some active-duty soldiers. Bartlett was hesitant. This still wasn’t something for mass production. But saying ‘no’ to the military is hard to do.
In 2009, amputee soldiers got their first BTK production unit. Since then, Bartlett has worked regularly with active soldiers and veterans. “Now we just work where the need is, whether it be active duty still, veteran or civilian,” he says. He told me he couldn’t talk about the details of his work, but that when fitting soldiers one thing is made very clear to him: it had better work.
Most prosthetic legs don't have the elasticity of Bartlett's knee (Credit: Getty Images)
For a while, the military made up the entirety of Left Side Inc’s business. But eventually they started selling on the open market. Today, Bartlett has a company and a product. He says it still feels very sudden – indeed, it took several years for him to stop racing and focus entirely on the business.
He finally gave up racing in 2011. Greg Mattson remembers that time well: “A couple of years ago he was jumping some huge gap and didn’t make it. He shattered his whole helmet and had to have his face stitched up. And I was like, ‘Dude, you’re getting too old for this. We have an investment’.”
Bartlett’s leg can be used in water, here for snorkelling and paddle boarding
“I’m not a business guy,” Bartlett said every time we talked. He has no idea how many legs he’s built – “I build them all by hand, about 20 at a time.” For him, it’s not about making money; it’s about helping fellow amputees. If he had it his way, they’d be giving the knee away for free. “When someone orders something from us, they’re missing something in their life. They want it back. I don’t think of this as a product. Other guys, they’re not amputees, they don’t get it.”
Mattson is one of those other guys, and they clash sometimes. He says that sometimes Bartlett will reject ideas for changes that might make the knee cheaper. But if it makes the knee look bad, Bartlett won’t do it. “He’s idealistic – he wants this knee to be perfect, even in the machining he wants it to look beautiful and have curves here and there. We butt heads. You might get two guys at a meeting who say we can cut half that cam off, and he says it makes it look funny.”
What was once a wide-open market is now a crowded one. In the commercial market, two other prosthetic knees (the XT9 made by K12 Prosthetics and the Moto Knee made by Biodapt) compete for the tiny sliver of amputees who are healthy and active enough to want something for sports – and are able to afford it. Bartlett's knee costs about $6,000 (£3,900).
Extreme prostheses are now more widely visible than ever before. Bartlett’s competitors promote their products through advertisements, commercials and social media. In January 2013 Mike Schultz, the amputee who designed the Moto Knee, was on the cover of Wired magazine.
When he stopped racing, Bartlett gave up the thing he had fought to do for so long. He let his sponsorships go. But he started sponsoring other people in races and competitions, and travelling in person to ski events worldwide to help amputees try out the knee he still builds himself.
“That’s better than winning any race, doing any competition,” he says. “That’s the new high. Being able to give someone a part of their life back.”
This is an edited version of an article originally published by Mosaic, and is reproduced under a Creative Commons licence. For more about the issues around this story, visit Mosaic’s website here.
http://www.bbc.com/future/story/20150609-the-man-who-built-himself-an-extreme-knee
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