By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- ACL repair with stitches and biologic scaffold augmentation shows promising early results in a small group of patients
- The technique is now being studied in large groups of patients
- If the early results hold up it will be an excellent option for some ACL tears and avoid many of the possible problems with traditional ACL reconstruction
Our current best ways to treat a torn ACL is a surgical procedure called a “reconstruction”, where a substitute tissue (a “graft”) is used to replace the torn ACL. Tunnels or sockets are drilled in the bone, so the bone essentially grows into the new tissue and makes a new ACL.
ACL surgery has improved substantially over the last 30 years, with generally excellent results. But there can be issues related to the bone tunnels potentially causing growth disturbance in young athletes, and issues related to the removal of the graft. A new type of ACL repair using stitches and a biologic scaffold to enhance healing is showing very exciting early results. If this ACL repair technique proves itself in larger clinical studies, we can expect it to be an excellent option to avoid tunnels and grafts for some ACL tear types.
“BEAR”= Bridge Enhanced ACL Repair
The technique, called “bridge enhanced ACL repair”, or “BEAR”, was pioneered by orthopedic surgeon Dr. Martha Murray at Boston Children’s Hospital. In a recent journal publication, Dr. Murray and her colleagues report on a clinical trial comparing 10 BEAR ACL repairs with 10 traditional ACL reconstructions.
The results are outstanding in both groups. There were no re-tears in either group out to two years. No complications related to the surgery in either group. Knee stability and functional tests were also excellent in both groups.
This type of study is called a clinical trial, and when a surgical technique is very new the early trial is designed to show safety, and to get a general sense that the technique has enough promise to support a larger clinical trial. This early clinical trial definitely has positive results, which will now need to be proven in larger clinical trials.
The biologic scaffold is likely the key to success
I certainly hope that the early positive results are also found in the larger clinical trials. The key factor with the BEAR technique appears to be the biologic scaffold, since suture repair without the scaffold has shown poor results.
If the early BEAR results hold up, it will then be possible to start performing the procedure in the general population. Researchers will also be able to better define exactly which kinds of ACL tears and which groups of patients will benefit most from the procedure. I was very excited to hear about this technology a few years ago and continue to be optimistic about how it will turn out.