An Isolated Midsubstance ACL Tear Repaired With the BEAR System

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomaterials Science

Background:

• Anterior cruciate ligament (ACL) repair historically had high failure rates, leading to decreased use.
• The Bridge-Enhanced ACL Repair (BEAR) implant has revitalized interest in primary ACL repair techniques.
• The BEAR implant is an arthroscopic technique using a novel implant and autologous blood for midsubstance ACL tears.

Purpose of the Study:

• To present a detailed step-by-step surgical technique for isolated midsubstance ACL repair using the BEAR implant.
• To outline the indications and methodology for the BEAR implant procedure.
• To provide a technical guide for surgeons performing BEAR implant surgery.

Main Methods:

• Diagnostic arthroscopy to confirm ACL rupture and tibial stump presence.
• Suturing of the residual ACL stump with #2 Vicryl suture.
• Creation of femoral and tibial tunnels, followed by Endobutton fixation.
• Hydration of the BEAR implant with autologous blood and passage through tunnels.
• Tensioning and fixation of the implant to the proximal tibia with a second Endobutton.

Main Results:

• The BEAR technique demonstrated noninferiority compared to ACL autograft reconstruction.
• Results were assessed using the International Knee Documentation Committee (IKDC) score and anteroposterior laxity measurements.
• Improved hamstring strength and a reduced incidence of contralateral ACL tears were observed at 2 years postoperatively.

Conclusions:

• The BEAR implant and technique represent a promising advancement in ACL repair.
• Initial data suggest favorable outcomes, including improved strength and reduced re-injury rates.
• Further long-term studies are necessary to fully establish the clinical efficacy of the BEAR technique compared to traditional autograft reconstructions.