Various Technique Modifications of BEAR ACL Restoration.

Background: Anterior cruciate ligament (ACL) injuries are incredibly common, with an annual incidence of 68.6 per 100,000. The Bridge-Enhanced ACL Restoration (BEAR) is a relatively novel technique that combines suture repair of the ligament and a bioactive scaffold implant to bridge the gap between the torn ligament ends. Since the adoption of the BEAR technique, several modifications have been made to the original technique. These modifications are being prospectively studied within the Bridge registry. Indications: ACL tears amenable to repair. Technique Description: The described technique demonstrates 2 common modifications to the original BEAR technique. The first technique passes 2 luggage tag-style sutures onto the ACL stump. These are then passed into a tensionable suture loop and button assembly. This is passed through a femoral tunnel, securing the ACL stump to the femoral footprint. Bridging sutures are attached to the button, passed through the BEAR Implant, and brought through a tibial tunnel. The second demonstrated technique again passes 2 luggage tag style sutures through the ACL stump and secures them to the femoral footprint using a knotless anchor. Bridging sutures are passed through the BEAR Implant, out a tibia tunnel, and fixed to the tibia with another knotless anchor. In both techniques, the preparation of the BEAR Implant is the same and is completed without arthroscopic visualization. Results: In our experience, patients undergoing BEAR with real-world technique modifications have achieved successful outcomes. The Bridge registry has prospectively followed these patients and has published their early results. With the first 100 patients, they showed an ACL retear rate of 5% at 2 years. Furthermore, there has been a low rate of adverse events, and 61% of patients have been able to return to sport at 9 months. Discussion/Conclusion: Several technical modifications have been developed for the use of the BEAR Implant in ACL repair. These approaches demonstrate promising early outcomes and enable surgeons to tailor the procedure according to their preferences and level of expertise. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.