BEAR acl repair procedure

A snowHead

I'm not sure if this has been covered here previously, I did a quick search and couldn't find anything. My acl is fortunately fine, but I just happened to see a CBS TV news report on a relatively new acl surgical repair procedure called BEAR (Bridge-enhanced anterior cruciate ligament repair). Unlike conventional surgery where an autograft is used (i.e a piece of ligament is taken from elsewhere on the patient's body, usually the rear of the leg) with the BEAR procedure a matrix scaffold saturated with the patient's blood to promote cell growth is placed in the gap between the torn ends of the acl.

Here's a paper on a 2 year study on the effectiveness of the BEAR procedure compared to conventional acl reconstructive surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431773/#:~:text=Bridge%2Denhanced%20anterior%20cruciate%20ligament%20repair%20(BEAR)%20combines%20suture,ACL%20to%20facilitate%20ligament%20healing.

A snowHead

Interested to get Jonathan Bell's view on it

Well, the person's real but it's just a made up name, see?

Thank you @holidayloverxx,
Martha Murray has been developing this technique in Boston. I have heard her speak on her research program and she has been meticulous.
She has done a large amount of basic science research and a small number of cases as part of a trial.

The problem that she is working on is that ACL ruptures that are repairable only account for 10% of all ruptures and that there are multiple studies that have proven that attempts to repair any of the remaining 90% will result in failure.One of the reasons that these repairs fail is that the injured ligament shreds and therefore ends up too short to bridge the gap fully between the tibia and the femur. In repairable ACL the ligament, although pulled away from the bone, is complete and not shortened so can be simply reattached to the bone. The BEAR is an attempt to bridge the gap with a piece of specialised sponge which it is hoped will then be turned into new ligament. The interior of the knee is an extremely harsh environment for healing so they have their work cut out to be able to achieve this.

The BEAR group have a small number of patients treated. So whilst the early small scale study has been done it was really done to give the green light to allow a bigger study to be carried out. We should not read too much into the small study as the number of patients isnt enough to prove the technique is statistically better than what we do at present. They will need to enter large numbers into a study that compares BEAR against standard treatment and follow them for minimum 2 years. For the technique to be definitely proven the follow up will need to be 5 years.Im sure they are recruiting and following up their patients at the movement.

The dilemma faced when new techniques are available is that many patients assume that new techniques will be always better than what went before. Sadly, many so called advances are then eventually proved to be inferior ie you would have been better sticking with the tried technique.A good example of this is the double bundle ACL reconstruction which was widely offered by the great and the good but after any years were proved to be no better or worse. When the latest comes along I have to contain my FOMO by not jumping on every latest bandwagon whilst we wait for proper proof the new technique is better. That means i may adopt some thing a little later than those who experiment with everything new. On the other hand i’m not doing surgeries that have a significant chance of being worse than standard techniques. A good current example is robot assisted knee replacement which is very big now but has never, in 15 years, been proven to be better for the patient. My gut instinct is that we may eventually see benefit in unicompartment knee replacement but i’m still not convinced we will see improvement in standard knee replacement.

Any way i digress. In essence BEAR is going to potentially be an exciting advance if it works but we don't know if it will work. Credit must go to the company behind it that haven’t just released it onto the market before we have proof. Do post more questions if any SH want more answers. Jonathan Bell

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@Jonathan Bell, fascinating. Thank you so much for sharing your thoughts.

Anyway, snowHeads is much more fun if you do.

@Jonathan Bell, thank you

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@Jonathan Bell, very interesting.

Help!!

BEAR acl repair procedure

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