The Bridge-Enhanced ACL Repair: A Review

Abstract

The mainstay of treatment for injuries to the anterior cruciate ligament (ACL) is with a tendon graft harvested from elsewhere in the knee. This procedure, known as ACL reconstruction (ACLR), has excellent reported outcomes in terms of restoring the gross stability of the knee. However there are reported rates of graft failure in the pediatric population.1 ACL reconstruction also does not provide full protection from developing premature osteoarthritis, which is often seen in patients after ACL injury. A new method must be found in order to find a solution to these adverse outcomes from the current standard treatment of ACL injuries. The Bridge-enhanced anterior cruciate ligament repair (BEAR) technique is a new innovation on primary repair of a torn ACL. It avoids the requirement for autograft harvesting and use of an allograft by combining a primary suture repair with an extraceullular matrix scaffold (the BEAR scaffold). This scaffold is placed between the two torn ends of the ACL to help facilitate natural healing of the ligament in order to restore the intrinsic functions of the ACL to protect the knee from trauma and instability. This ability to repair the native ACL maintains the proper anatomy of its insertion points, avoids donor site morbidity, and helps to prevent early osteoarthritis by maintaining innate proprioceptive functions of the ACL. Our study will prove the BRIDGE repair to be a promising step in the direction of preserving the native ACL.