ACL Repair with BEAR Implant

Because the BEAR is a newer procedure, we don’t yet have all the evidence on who is best for this surgery. BEAR is typically recommended for individuals who have recently experienced an ACL tear and are active or wish to maintain an athletic lifestyle. The BEAR procedure does need to be done in patients who had their tear recently, and is optimal in patients who have torn their ACL in a certain way. Additionally, some evidence shows that the re-tear risk might be higher in young athletes as opposed to older ones. As an expert knee surgeon, Dr. Mayo will be able to assess your individual situation to determine whether you’re a suitable candidate for the BEAR procedure.

Before the surgery, anesthesia will be administered to put you to sleep for the surgery. You will also get a nerve block to make your leg numb. As with other ACL procedures, the first step is for Dr. Mayo to make two small incisions to insert a camera to view the knee joint. The torn ends of the ACL are then prepared, and sutured to bring them back to where they normally attach. Then, the sponge-like scaffold is soaked in the patient’s blood, then inserted into the space between the two torn ends of the ACL. The scaffold and the ligament ends are then secured using stitches or sutures. The blood-soaked scaffold facilitates the natural healing process, allowing the ligament to regrow through the scaffold.

Recovery from the BEAR procedure can vary among individuals, largely depending on their general health and activity level. Desk jobs or light activities can typically be resumed within a few weeks post-surgery. Return to physically demanding jobs or high-level sports can take up to nine months or more. This allows the regrown ACL sufficient time to strengthen and stabilize the knee joint.

After the procedure, you will be in a recovery room where medical staff will monitor you as the anesthesia wears off. It’s likely that you can go home on the same day. Your knee may be immobilized with a brace, and crutches will be provided for initial mobility. Pain medications will be prescribed to manage any postoperative discomfort.

Physical therapy is crucial to the recovery process following a BEAR procedure. A typical rehabilitation program looks like this. It is slightly slower at first compared to normal ACL rehab to allow the graft to heal.

Early Stage (Weeks 1-4): The primary objectives are to reduce swelling, regain full knee extension, and gradually increase weight-bearing. You will be guided through gentle range-of-motion and muscle-strengthening exercises.

Middle Stage (Weeks 4-16): As your knee continues to heal, you will begin advanced strengthening exercises, flexibility exercises, and balance training.

Late Stage (Weeks 16 and beyond): This phase includes sport-specific or job-specific training, including agility drills, plyometrics, and other high-intensity exercises.

As with any surgical procedure, BEAR has potential risks, albeit rare:

• Infection: Occurs in less than 1% of patients. Preventive antibiotics are administered before surgery to reduce this risk.
• Blood clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) can occur but are rare (less than 1%). Aspirin is given after surgery to minimize this risk.
• Failure of ligament healing: There’s a chance that the repaired ligament does not heal adequately, leading to recurring knee instability. This occurs in approximately 5-15% of cases.
• Stiffness or loss of motion: About 5% of patients may experience some level of stiffness or loss of motion in the knee.
• Nerve or blood vessel damage: This is very rare but could result in numbness or weakness in the leg.

Choosing not to undergo the recommended surgery for ACL injury could result in:

• Increased knee instability: The untreated ACL tear could cause your knee to frequently “give way,” potentially leading to falls and further injuries.
• Further damage to the knee: Continued knee instability might cause damage to other structures within the knee, such as the meniscus or cartilage, leading to premature onset of arthritis.
• Limited function: You may be unable to return to your usual level of physical activity, including sports or demanding physical work.