Physical Therapy for Bridge-Enhanced ACL Repair (BEAR)
What is a Bridge-Enhanced ACL Repair (BEAR) implant?
A Bridge-Enhanced ACL Repair (BEAR) implant is a relatively new surgical technique designed to repair the anterior cruciate ligament (ACL) in the knee without the need for traditional grafts. According to this article, the BEAR procedure uses a biologically enhanced implant, which is a bridge-like material placed between the torn ends of the ACL.
This implant supports healing by stimulating tissue growth and promoting the natural healing of the torn ACL. The BEAR technique leverages the patient’s own biology to regenerate the ACL rather than replacing it with a synthetic graft or donor tissue, offering the potential for better functional outcomes and reduced long-term complications compared to traditional ACL reconstruction, according to this article.
Who is a good candidate for a Bridge-Enhanced ACL Repair (BEAR)?
According to this article, the ideal candidates for the BEAR procedure are generally individuals with acute ACL tears, typically occurring within 1 to 2 weeks of the injury.
Other key factors include:
Age and Activity Level: Young, active individuals (ages 14–40) who participate in sports and want to preserve their native ACL without the need for a graft. According to this study, BEAR resulted in similar patient-reported outcomes and knee laxity but significantly higher hamstring muscle strength when compared with autograft ACL reconstruction (ACLR) at 2-year follow-up in a young and active cohort.
Tear Characteristics: Patients with partial or complete ACL tears, particularly those with a clear, clean tear pattern where the ligament can be well approximated during surgery.
General Health: A good candidate would also be in overall good health, with no significant pre-existing knee arthritis or conditions that might interfere with healing.
Motivation for Rehabilitation: Patients who are motivated and able to adhere to a rigorous rehabilitation protocol are preferred for BEAR.
How is a Bridge-Enhanced ACL Repair (BEAR) different from an ACL Reconstruction?
The primary difference between BEAR and traditional ACL reconstruction lies in the approach to repair the torn ACL.
Traditional ACL Reconstruction: Involves removing the torn ligament and replacing it with a graft, typically taken from the patient’s hamstring, patellar tendon, or a cadaver donor. The reconstruction aims to restore the mechanical function of the ACL but may require a longer recovery time and often leads to the formation of scar tissue at the site of the graft.
Bridge-Enhanced ACL Repair (BEAR): Rather than using a graft, the BEAR procedure involves using a biocompatible implant to bridge the gap between the torn ends of the ACL. This implant helps to guide the body’s natural healing process by promoting tissue regeneration and restoring the ligament without removing the damaged tissue. This method may offer a more natural healing process and better retention of the knee’s native structure, as explained in this article.
Rehab protocol for Bridge-Enhanced ACL Repair (BEAR)
The rehabilitation protocol for BEAR typically focuses on restoring the knee's range of motion, strength, and function over time. While rehabilitation can vary depending on the specific surgery and the patient's response, the following general phases are typically observed:
Phase 1: Initial Recovery (0–6 weeks)
Goals: Protect the healing ACL and reduce inflammation.
Focus on: Range of motion exercises, weight-bearing as tolerated, and gentle strengthening of the surrounding muscles (quadriceps, hamstrings).
Avoid: Heavy impact or twisting motions that could disrupt the repair site.
Phase 2: Early Strengthening and Mobility (6–12 weeks)
Goals: Gradually increase the strength of the quadriceps and hamstrings, while improving the knee’s stability.
Focus on: Controlled leg presses, squats, and low-impact cardiovascular exercises (cycling or swimming).
Begin light sport-specific drills if tolerated, including gentle running on a treadmill or using an elliptical machine.
Phase 3: Functional Strength and Conditioning (3–6 months)
Goals: Improve strength, agility, and overall function of the knee.
Focus on: Advanced strengthening exercises, proprioception training, balance drills, and functional movement patterns such as jumping or cutting.
Phase 4: Return to Sport (6–12 months)
Goals: Safe return to high-impact sports and activities.
Focus on: Plyometric exercises, sport-specific movements, and gradual return to activities like running, pivoting, and jumping.
Throughout the rehabilitation process, patients are closely monitored by their orthopedic surgeon and physical therapist to ensure the knee is healing correctly and progressing as expected. Full recovery may take 9–12 months, with return-to-sport clearance typically being given after a thorough assessment of strength, stability, and function.
Conclusion
If you’re dealing with knee pain from an ACL injury and want to consult us in the rehab process, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy