(BEAR) Bridge-Enhanced ACL Repair Miami
What is the BEAR Implant for ACL Repair?
Bridge-Enhanced ACL Repair (BEAR) is an innovative FDA-approved method for repairing torn anterior cruciate ligaments (ACLs) using a specialized implant. ACL tears commonly happen during sports that involve pivoting and cutting, like football, soccer, and basketball. Dr. John Phillip Wilkerson Jr. is among the few surgeons offering this technique. Unlike traditional ACL surgery, which uses a graft from another part of the body, the BEAR technique employs the BEAR Implant to connect the torn ACL ends. This resorbable implant, made from purified bovine collagen, is secured with sutures and absorbs into the body over time. During surgery, the patient's blood is injected into the implant to promote healing. Within about 8 weeks, the implant is replaced by the body’s own tissue, eliminating the need for graft tissue from elsewhere.
Anatomy of the ACL
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring repair to correct the abnormality.
Indications for ACL Repair Surgery using the BEAR Implant
ACL repair using a BEAR implant is recommended for patients aged 14 and older with a complete ACL tear confirmed by MRI. The procedure should occur within 50 days of the injury, and there must be an ACL stump attached to the tibia for successful restoration. The BEAR implant is effective for various tear types (type 1 to type 4). ACL injuries often happen during sports when the knee is twisted or hyper-extended, especially during sudden direction changes, abrupt stops, or incorrect landings.
Preparation for ACL Repair Surgery with the BEAR Implant
In general, preparation for ACL repair surgery with the BEAR implant will involve the following steps:
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Your doctor will review your medical history and conduct a physical exam to identify any issues that need addressing before surgery.
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Based on your medical and social history, as well as your age, you might need tests like blood work and imaging to find any abnormalities that could affect the procedure's safety.
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You'll be asked about any allergies to medications, anesthesia, or latex.
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Inform your doctor about any medications or supplements you're taking and any conditions like heart or lung disease.
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You may need to stop certain medications, like blood thinners and anti-inflammatories, for a week or two before surgery.
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Avoid alcohol and tobacco for several days before and weeks after surgery, as they can slow healing.
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Do not eat or drink anything for at least 8 hours before surgery.
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Arrange for someone to drive you home after the surgery.
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You'll sign an informed consent form after discussing the surgery's pros and cons.
Procedure for ACL Repair with the BEAR Implant
ACL repair surgery with a BEAR implant is usually performed under general anesthesia in a minimally invasive arthroscopic technique. In general, the procedure involves the following steps:
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Your surgeon will make two to three small cuts, each about 1/4 inch long, around your knee.
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An arthroscope is inserted into the knee joint through one of the cuts.
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An arthroscope is a thin tube with a camera, light, and magnifying lens that connects to an external monitor, allowing your surgeon to see inside the knee joint.
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A sterile solution is pumped into the joint to expand it, giving your surgeon a clear view and space to work.
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Miniature surgical tools are used through the other cuts to place the BEAR implant between the torn ACL ends, helping them heal while keeping their original attachments.
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The patient's blood is added to the BEAR implant to trigger clot formation, which supports cell migration and growth.
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The BEAR implant is secured by stitching the torn ACL ends onto it.
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Within 8 weeks, the BEAR implant will be absorbed by the body and replaced by new cells and tissues that form the new ligament.
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After confirming the repair, the scope and instruments are removed, and the cuts are sutured and bandaged.
Postoperative Care and Instructions
After ACL repair surgery with the BEAR implant, you will be monitored in the recovery area for any reactions and vital sign changes. Pain, swelling, and discomfort are common and managed with medications, while keeping your leg elevated helps reduce swelling. You’ll use assistive devices like crutches and follow weight-bearing restrictions, gradually increasing mobility to prevent blood clots. Wound care and hygiene instructions will be provided, and strenuous activities should be avoided for several months, with heavy lifting restricted for at least six months. A personalized physical therapy program will help strengthen the knee and restore function. Most patients can resume daily activities within 1–2 months, return to work around 6 weeks (longer for physically demanding jobs), and achieve full recovery, including return to sports, in 9–12 months, with regular follow-up appointments to track progress.
Benefits of ACL Repair with the BEAR implant
The BEAR implant for ACL repair offers several advantages over traditional ACL reconstruction with a graft. It eliminates the need for graft tissue, reducing the risk of autograft or allograft complications, and lowers the likelihood of post-traumatic osteoarthritis. Patients often experience better hamstring strength, higher knee function scores, and a superior return-to-sports index. The procedure restores the native ACL and its function, is minimally invasive, allows for easier revision surgery if needed, and generally results in better overall functional outcomes.
Risks and Complications
ACL repair surgery with a BEAR implant is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
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Infection
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Bleeding
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Knee pain
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Allergic/anesthetic reactions
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Re-tear or reinjury
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Blood clot or deep vein thrombosis
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Damage to adjacent soft tissue structures
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Stiffness or limited range of motion
