Historically, ACL repair was associated with poor results, but newer repair techniques have shown impressive benefits. Both ACL repair and reconstruction are minimally invasive arthroscopic procedures. Reconstruction is the gold standard of care for a torn ACL and has a high rate of success but can take 6-12 moths for full recovery. Repair is focused on keeping the torn ligament in place to promote self-healing. Whether repair is an option depends on many factors including the specifics of the injury, the type of the tear, the time since the tear occurred, and the patient’s individual circumstances.
A recent study found that both repair and reconstruction lead to similar functional outcomes. However, patients who receive repair may have less pain, earlier return of range of motion, and faster rehabilitation. The type of tear is of critical importance to the potential success of primary ACL repair.
Suture Anchor Primary Repair
ACL primary repair with suture anchors, also known as direct ACL repair, is a surgical technique used to treat certain types of ACL tears. Unlike traditional ACL reconstruction, which involves removing the torn ACL and replacing it with a graft, primary ACL repair involves suturing (stitching) the torn ends of the ACL back together.
In primary ACL repair with suture anchors, small devices known as suture anchors are used to help reattach the torn ligament. The anchors are inserted into the bone at the point where the ligament originally attached, and the sutures attached to these anchors are used to pull the torn ends of the ligament back into position. Over time, the goal is for the ligament to heal in this position, restoring its normal function.
This approach has a few potential advantages over traditional ACL reconstruction. For example, it preserves the patient’s own ligament, which might lead to a more natural-feeling knee. It also avoids the need for a graft, which can reduce pain and complications associated with graft harvest.
The Bridge-Enhanced ACL Restoration (BEAR)
The BEAR technique is a newer approach to ACL injury repair. It is minimally invasive and allows the ACL to heal itself. The BEAT implant received FDA-approval in December 2020 for specific indications.
BEAR combines suture repair of the anterior cruciate ligament with a specific extracellular matrix scaffold, the BEAR scaffold, that is placed in the gap between the torn ends of the ACL to facilitate ligament healing.
In traditional ACL reconstruction, the torn ACL is replaced with a graft taken from another part of the patient’s body or from a cadaver. While this procedure is generally successful, it does have some drawbacks, such as pain at the graft harvest site, potential weakening of the other structures from which the graft was taken, and variability in graft quality.
The BEAR technique is different because it aims to stimulate healing of the torn ACL instead of replacing it with a graft. A small, sponge-like scaffold is inserted into the joint, bridging the gap between the two torn ends of the ACL. This scaffold is then saturated with the patient’s own blood, creating a conducive environment for the torn ends of the ACL to grow together and heal.
The implant is made of bovine cartilage and is secured via a suture to bridge the gap between the torn ends of the patient’s ACL. It is resorbable meaning it is absorbed by the body within 8 weeks after the BEAR procedure. Studies demonstrate that biomechanical outcomes were equivalent to that of ACL reconstruction.
This approach has several potential advantages:
- Preserving the original ACL: the BEAR technique allows the original ACL to be preserved, which might lead to a more natural-feeling knee compared to traditional ACL reconstruction.
- Avoids a second surgical site: The BEAR implant does not require a second surgical site to remove a healthy tendon from another part of the body.
- Avoiding graft-related complications: Because there’s no need for a graft, the BEAR technique eliminates potential complications related to graft harvest or quality.
- Potentially faster recovery: Some early evidence suggests that patients might recover faster with the BEAR technique compared to traditional ACL reconstruction.
- It also preserves the possibility of an ACL reconstruction if the repair fails.
The BEAR implant offers a viable alternative to traditional ACL reconstruction in the appropriate patient.