Thoughts on the BEAR Knee ACL Implant

Patients have asked for my professional opinion on the recent Wall Street Journal article (“An ACL Tear That Heals Itself?", WSJ 9/3/2022), as an orthopedic surgeon that utilizes regenerative sports medicine treatments.

Here are my thoughts :

An admirable job by Dr. Murray and her colleagues at Boston Children’s Hospital, doing the basic research and applying it to the surgery of ACL tears of the knee, a common sports injury at all ages.

In many ways, the BEAR procedure is the natural evolution of (my mentor) Richard Steadman’s ”healing response” for ACL tears of the femoral origin, often seen in competitive skiers. What they have added is a scaffolding and suture fixation to further enhance the native repair of the ligament. Their early results are impressive, with excellent healing and objective stability at two years. Comments:

- The second study group extends the repair to a younger age group, from 18 to 13 years of age and they are no longer recommending it for just the “proximal“ tears (similar to Steadman); more common mid-substance tears are now included.

- I have some concerns about the early stability/KT measures as reflecting tissue healing vs. suture “stress shielding” of the ligament. In other words, will the repair of the native tissue hold up with time, as ligament reconstruction has.

-Potentially less risk of degenerative arthritis developing after ACL tear/repair vs. reconstruction is the real “holy grail“ of this procedure. The feeling is that preserving the natural tissue and nerve endings (“proprioception“ ) is valuable in preventing wear and tear, especially in younger, more active individuals. Time will tell.

-As a orthopedic surgeon specializing in the use of PRP and cell-based (formerly “Stem Cell”) therapy, the choice of whole blood to “bio-enhance” ACL repair is interesting. We will see if that ends up being the best adjunct for ligament re-growth.

My current opinion is, recognizing the ongoing studies to validate the above, I will approach use of the BEAR implant as feasible for the younger patient, reserving the "gold standard" of reconstruction for adults and the higher level athlete.

I use Biologics such as PRP and cell-based therapies on selected partial and proximal ACL & meniscus tears, articular (joint) cartilage injuries of the knee and shoulder, rotator cuff tears, and as an alternative to arthritic joint replacement.

I am happy to sit down with patients and their families and discuss surgical and nonsurgical alternatives based on clinical studies, current research and 30+ years of experience.

Kelly Cunningham MD

Austin OrthoBiologics austinorthobio.com

Austin, Texas info@austinorthobio.com

Board-certified, Orthopedic Surgery

Regenerative Sports Medicine

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