Anterior Cruciate Ligament (ACL) injuries are among the most common knee injuries, especially in athletes and active individuals. Traditionally, ACL reconstruction (ACLR) has been the standard surgical treatment, but a newer technique, the BEAR ACL Repair procedure, offers an alternative that preserves the native ACL tissue. This biological repair method utilizes a special implant to stimulate healing and restore the ligament without requiring a graft.
In this blog, we will discuss the indications, prerequisites, contraindications, surgical procedure, and success rate of the BEAR procedure.
What is the BEAR Procedure?
The Bridge-Enhanced (BEAR ACL Repair) procedure is an innovative approach that promotes natural healing of the torn ACL instead of replacing it with a graft. The technique involves using the BEAR implant, a bioengineered sponge infused with the patient’s own blood, to stimulate healing and ligament regeneration. This method preserves the native ACL, allowing for a more natural recovery process compared to traditional ACL reconstruction.
Indications: Who Can Benefit from BEAR ACL Repair?
The BEAR procedure is most effective for patients who meet the following criteria:
- Partial or complete mid-substance ACL tear (not near the ligament’s attachment to the bone)
- Recent ACL injury (within 50 days of the tear)
- Good ACL tissue quality (sufficient remaining fibers for repair)
- Younger patients (<30 years old) with a high healing potential
- Non-smokers or individuals with good overall health (smoking can delay healing)
- Patients seeking to avoid graft harvesting complications (e.g., hamstring or patellar tendon grafts)
Prerequisites for BEAR Surgery
Before undergoing the BEAR procedure, patients must:
- Undergo an MRI scan to confirm eligibility based on ACL tear type and location.
- Have intact knee alignment and no major ligament instability.
- Avoid smoking and maintain a healthy lifestyle to promote tissue healing.
- Be committed to rigorous physiotherapy post-surgery for successful rehabilitation.
Contraindications: Who is NOT a Candidate for BEAR?
- Chronic ACL tear (injuries older than 50 days) with significant ligament degeneration
- ACL tear near the femoral or tibial attachment (not in the mid-substance)
- Multi-ligament injuries (damage to PCL, MCL, or LCL)
- Severe knee instability that requires full ligament reconstruction
- Patients with poor healing capacity, such as smokers, diabetics, or individuals with connective tissue disorders
- Older patients (above 40) with reduced biological healing potential
BEAR Surgical Procedure: Step-by-Step
The Bridge-Enhanced ACL Repair (BEAR) procedure is performed under arthroscopic guidance and follows these key steps:
Step 1: Preparation
- The patient is placed under general or regional anesthesia.
- Small incisions are made to insert the arthroscope and surgical tools.
Step 2: ACL Stump Preparation
- The torn ends of the ACL are identified and lightly debrided to prepare for repair.
- The surgeon assesses the ACL quality to ensure sufficient remaining fibers for successful healing.
Step 3: Placement of BEAR Implant
- A bioengineered sponge (BEAR scaffold) is placed between the torn ACL ends.
- The surgeon injects the patient’s own blood into the sponge to create a healing matrix.
- The implant stimulates cell growth and tissue regeneration.
Step 4: Securing the Ligament
- Sutures are used to pull the ACL stump into the scaffold and secure it in place.
- This ensures the ACL fibers connect and heal naturally over time.
Step 5: Closure and Post-Surgical Care
- The incisions are closed with sutures.
- A knee brace is applied to restrict movement and protect the healing ligament.
- Post-surgical rehabilitation begins within days to restore mobility and strength.
Success Rate of BEAR ACL Repair
Recent studies have shown promising results for the BEAR procedure.
80-90% success rate in properly selected candidates
Comparable knee stability to traditional ACL reconstruction at two-year follow-ups
Reduced muscle atrophy compared to graft-based ACL reconstruction
Better proprioception (joint position sense) due to ACL tissue preservation
Lower risk of donor-site complications (e.g., no patellar tendon or hamstring weakness)
However, long-term studies are still ongoing to compare re-tear rates and long-term knee function compared to traditional ACL reconstruction.
Advantages of BEAR ACL Repair Over Traditional ACL Reconstruction
- Preserves Native ACL Tissue: Unlike traditional ACL reconstruction, which replaces the ligament, BEAR allows the ACL to heal itself.
- No Need for Graft Harvesting: Avoids the risks associated with hamstring, patellar tendon, or allograft harvesting.
- Faster Quadriceps Recovery: Patients experience less muscle atrophy, leading to quicker strength restoration.
- Less Risk of Osteoarthritis: Since the original ligament is preserved, BEAR may reduce the long-term risk of knee osteoarthritis.
Conclusion: Is BEAR ACL Repair Right for You?
The Bridge-Enhanced ACL Repair (BEAR) procedure represents a groundbreaking advancement in ACL treatment. For young, active patients with recent ACL injuries, BEAR offers an effective alternative to traditional ACL reconstruction, with the benefit of preserving the native ligament and reducing long-term complications.
However, not all ACL tear qualify for BEAR, and patient selection is crucial. If you have suffered an ACL tear and are considering your treatment options, consult with a sports medicine specialist or orthopedic surgeon to determine if the BEAR procedure is right for you.
At The Cruciates, we provide expert consultation and advanced treatment options for ACL injuries. To learn more or to schedule an appointment, visit The cruciates today!
FAQs
How long does recovery take after BEAR ACL repair?
Recovery time is similar to ACL reconstruction—typically 6-9 months before returning to sports.
Is BEAR surgery less invasive than ACL reconstruction?
Yes, since it avoids graft harvesting, BEAR is considered less invasive.
Does insurance cover the BEAR procedure?
Coverage depends on your insurance provider, but BEAR is FDA-approved and gaining recognition.
What is the biggest limitation of BEAR ACL repair?
BEAR is not suitable for chronic or complex ACL tears and requires strict patient selection.
For more information and expert guidance, visit the cruciates
