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Bob's ACL WWWBoard
Re: Help refurbishing old Lenox Hill brace -- Maybe a new brace would be best...
Posted By: Michael Frind
Date: Friday, 12 June 2009, at 3:47 p.m.
In Response To: Help refurbishing original derotation knee brace made by lenox hill (Nancy -nh)
Dear Nancy,
The original Lenox Hill Derotation Brace (the term "derotation" is actually a trademark of the firm), a rather anachronistic contraption consisting of hinged metal bars surrounded by fabric wrappings, was discontinued a number of years ago. Part of the reason for the discontinuance was rooted in the ownership changes that the name has been through. But the discontinuance also had something to do with the advent of newer designs.
Lenox Hill Brace Company took its name from its home location, which was the neighbourhood (originally a town) of Lenox Hill in what is now New York City. The firm was considered one of the first to come up with a custom-made hinged knee orthosis that helped someone with a "trick knee" (i.e. unstable ACL-deficient knee) to have some hope of avoiding the horror of giving-way incidents, but while still having the opportunity to remain reasonably active in knee-demanding activities. (Unfortunately, as is widely known today but was not well known at the time, a knee that is so unstable that it gives out, regardless of whether braced or unbraced, is almost certainly incurring serious damage to articular cartilage and menisci, as well as to other structures such as the MCL, PCL, and LCL. This is why, in most cases, bracing is best used as an adjunct to ligament-reconstructive surgery.)
The Lenox Hill Brace Company later became part of SOGI (Seattle Orthopedic Group Incorporated), and was subsequently folded into the large orthotics-and-prosthetics conglomerate J.E. Hanger (now Hanger Orthopedic Group: www.hanger.com). Sadly, no trace of the Lenox Hill name can be found on the Hanger website. (I still have copies of old printed brochures from Lenox Hill, and also digital copies of the old Lenox Hill website, but all this is merely historical.)
The names "Lenox Hill" and "Derotation" still appear widely in literature pertaining to knee-ligament deficiencies, largely because this brace, being the first widely available product of its type, became synonymous with functional knee bracing. (The same naming phenomenon has occurred with other products such as Kleenex, Scotch tape, and Xerox copiers.)
For a brief while, the Lenox Hill name appeared on a number of relatively modern composite shell-type braces such as the LH2. (The original brace you have was briefly sold as the LH1.) In addition to the LH1 and LH2, the firm produced off-the-shelf shell-type knee braces such as the Precision Lite.
Previous respondent Dr. Mark Sanders noted that the Lenox Hill brace you have is of a vintage suitable for addition to a museum collection. (I am unaware of any museum that focuses specifically on functional knee braces, although I have often considered starting such a collection and then donating it to an educational institution.) With regards to your situation, the main question I see here is this: has there been a major change in the condition of your knee that has prompted you to take your old brace out of storage and return it to service?
If so, then I suggest you consult with your orthopedist or other knee-experienced specialist. Leg shapes and musculature commonly change subtly over time, thus often limiting the useful life of knee braces. However, some people can wear the same brace for many years on end with no fit-related problems (in which case all that is needed is regular preventive-maintenance-type service for the brace.) If your LH1 brace is something which you have not been using on a regular basis, then you might find that (even though it appears to still fit) it might be uncomfortable and painful to wear during activities. In such a case, it would be good to consult with an orthotist who specializes in fitting knee bracing.
Also, if your knee condition has recently changed or deteriorated, it would be a good idea to have the knee examined closely by an orthopaedist who focuses specifically on knees. Knee braces are great for protecting against sideways forcing and injurious hyperextension, but they should not be used in isolation if protection against twisting is required. If your knee is deteriorating rapidly, or if any ominous signs have appeared, then be sure to communicate this to your orthopedist at once.
Remember, too, that changes elsewhere in your legs can also affect the knee. One common example is changes (aging, degenerative change, injuries, surgeries) in the feet. Arch-height changes, the use of orthotics, ankle injuries, toe injuries, bunions, use of high heels (even if only in the past) can have very significant effects on the knees.
Other factors can also impact your knees (and by implication the functioning of knee bracing). Examples include knock-kneedness (genu valgum) or bowleggedness (genu varum), knees that hyperextend naturally to a great amount, a very heavy torso, and various connective-tissue disorders.
If your knee situation has not changed substantially since you received the LH1 brace, and if that brace still fits you and appears still capable of providing service (with a refurbishment), then getting it back into serviceable condition might be feasible but would require some research. Because Lenox Hill no longer has any corporate presence, you would need to find someone who is willing and equipped to refurbish your LH1 brace. And, this person would likely have to fabricate the necessary replacement parts by hand.
Some highly skilled orthotists might be able to refurbish your LH1 brace directly in their local shops. This would save you sending your brace away somewhere (and thus would save you the hassle of being without your brace for weeks on end). However, the issue of cost might be a problem, unless that orthotist has an old collection of spare parts or has some old LH1 braces he/she can cannibalize. (Orthotists with major fabrication shops typically focus on making assistive devices for people with major conditions such as cerebral palsy or limb paralysis. They commonly work in association with prosthetists, who make artificial limbs.)
All things considered, I think it might be most cost-effective to consider getting a brand-new custom-made functional knee brace. There are two commercially available models of brace which build closely on the same fundamental design principle embodied in the LH1. (This is the idea that the tibial crest, i.e. the bony ridge that runs down the front of your shinbone, should be grasped as firmly as possible in order to try to prevent the knee from twisting.) These two braces are the Townsend Air (a revision of the Townsend Original) and the Ossur CTi-Custom (formerly known as the Innovation Sports CTi2). Either of these two braces would be an excellent replacement for your existing LH1. The Air is not as light as the CTi2, and so if you intend to return to athletics (or if you expect to be wearing the brace for extended periods of time, for example on all-day hikes), then the CTi2 would be more suitable. The CTi2 is the brace I use, and I continue to be very pleased with it.
Above all, keep in mind that the key factor in the decision-making process is your knee. For a brace to be useful and safe to use, it must fit comfortably, be worn correctly (i.e. make sure that the strap immediately below the knee is the tightest, with the topmost strap being only gently tight), be maintained as required (e.g. repair of worn hinges, replacement of straps), and be refitted or replaced whenever changes in fit or leg shape call for this. Clearly, a brace that is unsupported (i.e. the manufacturer is no longer in business) is unlikely to meet these criteria. For this reason, I think your best bet is to retire your LH1 and replace it with a high-quality modern product.
Yours truly,
Michael Frind.
Knee Library http://factotem.org/library
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