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Bridge-Enhanced ACL Repair: A New Era for Sports Injuries

This blog post serves to simplify these scholarly papers:

The Issue

Every year, thousands of athletes, from high schoolers to pros in the big leagues like the NFL, NBA, and many other major league sports tear their ACL. It’s one of the most dreaded and prevalent injuries in sports, often followed by months of rehab and surgery.


For decades, the standard fix has been ACL reconstruction where surgeons remove the torn ligament and replace it with tissue from the patient’s hamstring or patellar tendon.


While effective, this approach comes with many trade-offs. Donor-site pain, long recovery times, and even lingering muscle weakness are just a few.


But what if the ACL could simply heal itself?


That’s the idea behind a groundbreaking new technique: Bridge-Enhanced ACL Restoration (BEAR).



What’s the ACL?

First, let’s understand what we’re working with. ACL stands for Anterior Cruciate Ligament. This is a tough ligament that runs through the middle of the knee joint, providing knee stabilization.

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It stops the tibia (shinbone) from sliding forward against the femur (thighbone) , keeps the knee stable during rotation or quick direction changes, and cushions the joint from impact during activities like jumping or running.


Vital for athletes.



What causes an ACL Tear?

  • Sudden changes in direction (like cutting or pivoting in a sport)

  • Awkward landing from a jump (ex. basketball, volleyball, gymnastics, etc.)

  • Stopping suddenly while running

  • Direct collision or blow to the knee (ex. football tackle)

  • Overextension of the knee (hyperextension)


What is BEAR?


Now we’re approaching the next big thing, Bridge-Enhanced ACL Restoration (BEAR). This procedure uses a bioengineered sponge-like scaffold soaked in the patient’s own blood, designed to connect the torn ends of the ACL which is simply just sutured together and repairs the ACL through the body’s natural healing process. (See Figure 1.)


This sponge-like scaffold is a collagen-based, short-term implant that offers support while soft tissues or bone heal and regenerate. Techniques including 3D printing, electro-spinning, and freeze-drying are used to produce scaffolds from biocompatible proteins or polymers. (See Figure 2.)


So instead of using tissue from elsewhere in the body and weakening that donor region, bio-engineers create their own material to help repair the ACL.




Figure 1. Diagram of the BEAR operative technique. Reproduced from Curr Rev Musculoskelet Med. 2025;18(4):140–148, under the terms of the CC BY-NC-ND 4.0 license.
Figure 1. Diagram of the BEAR operative technique. Reproduced from Curr Rev Musculoskelet Med. 2025;18(4):140–148, under the terms of the CC BY-NC-ND 4.0 license.


Figure 2. Image of the BEAR implant. Reproduced from Curr Rev Musculoskelet Med. 2025;18(4):140–148, under the terms of the CC BY-NC-ND 4.0 license.
Figure 2. Image of the BEAR implant. Reproduced from Curr Rev Musculoskelet Med. 2025;18(4):140–148, under the terms of the CC BY-NC-ND 4.0 license.


What does the research say?


Early Trials: A feasibility study in clinical trials found that BEAR produced similar outcomes to traditional reconstruction, but with one major perk, athletes kept more of their hamstring/patellar tendon strength. (See Figure 3.)


Post-Market Results: A 2024 retrospective cohort study of 58 patients showed excellent knee stability, full range of motion by 6 months, and no re-tears in the early follow-up period. Only 5% experienced stiffness.


Larger Reviews: A 2025 review summarized BEAR’s outcomes as non-inferior to standard ACL reconstruction, with re-tear rates around 15% in trials, but perplexingly, early real-world cases reported zero re-tears. However more studies are needed to determine the long-term effect of this new technique.


Ongoing Studies: Trials like BEAR-MOON are now comparing BEAR head-to-head with traditional reconstruction across multiple centers to see how it holds up long-term.


Figure 3. Figure from HSS J. 2024, showing patients’ levels of function before and after BEAR surgery. Adapted for educational use.
Figure 3. Figure from HSS J. 2024, showing patients’ levels of function before and after BEAR surgery. Adapted for educational use.

Why this matters


For athletes, this could mean more efficient rehab, less hamstring/patellar tendon weakness, and a future where ACL tears aren’t seen as the end of the world.


For doctors, the BEAR is part of a greater movement. Regeneration, not replacement. In sports medicine surgery the focus is now on letting the body repair itself rather than swapping out damaged parts.



The Bottom Line


BEAR needs to be the new gold standard for ACL repairs.


BEAR isn’t the conventional technique for ACL repair yet, however, it’s rapidly shifting from the lab to the operating rooms such as in one of the largest pediatric hospitals in the world, Boston Children’s Hospital. And if ongoing and future trials prove it’s worth, BEAR can be revolutionary in the “regeneration, not replacement” movement.


Medicine is entering a new era where the body doesn’t just get patched up, it gets a chance to heal itself.


More Areas of Research in Sports Medicine Surgery

  • Biodegradable fixation devices

  • Meniscus scaffolds and biologics

  • Tissue-engineered rotator cuff repairs

  • 3D-printed bone and cartilage grafts

  • Smart rehabilitation devices

 
 
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