Ask Dr. Skendzel: What Is A Bridge-Enhanced ACL Repair?

A possible breakthrough in knee ACL repair has been making news. Dr. Jack Skendzel explains how the new procedure works, and why it is different from the traditional ACL reconstruction in the knee joint.

New option for ACL repair

“Part of our mission at Summit Orthopedics is to make sure we can offer our patients the best and safest treatment options available,” says Dr. Jack Skendzel, a Summit surgeon specializing in anterior cruciate ligament (ACL) injuries. “Until now, the only way to treat a torn ACL has been to replace it with a graft. The new bridge-enhanced ACL repair is focused on healing the ligament instead of replacing it. It is an exciting idea.”

Each end of the ACL is attached to bones—the femur and the tibia—in the knee. When sports injuries or other trauma caused the middle of the ligament to tear, it was unable to repair itself and heal. The only way to fix the injury was to remove the torn ligament and replace it with a graft of tissue from the patient or from a cadaver: this is the traditional ACL reconstruction surgery.

“Some orthopedic surgeons wondered if there might be a way to get the ACL to heal itself, so grafting wouldn’t be necessary,” explains Dr. Skendzel. “They are currently conducting clinical trials to study the outcomes of a procedure that does exactly that.”

Bridge-enhanced ACL repair

The new technique is called the bridge-enhanced ACL repair (BEAR). Instead of replacing a torn ACL with a graft, the BEAR procedure “bridges” the torn ends of the ACL with a protein sponge that acts as scaffolding to encourage the ends of the ligament to grow back together. The sponge is placed between the torn ligament ends and injected with the patient’s blood to encourage the ligament to heal. Stitches hold the sponge in place and pull the torn ends of the ACL into the sponge and toward each other. The ends of the ACL grow into the sponge and reconnect. Over time, new ACL tissue replaces the sponge.

Comparing options

In comparing the two procedures, Dr. Skendzel explains that ACL reconstruction remains the standard surgical choice because over time it has been proved safe and effective. The BEAR procedure is promising, but experimental. Until there is more data on surgical outcomes, surgeons don’t have a full understanding of the risks and benefits of the BEAR procedure.

“Both procedures require an incision and involve arthroscopic techniques,” explains Dr. Skendzel. “When we do a reconstruction, the torn ACL is removed and replaced with a graft. If we use a graft from the patient, a graft harvest is part of the surgical process. With the BEAR procedure, a graft harvest is unnecessary, and the patient’s own ACL tissue is preserved, not removed.

“Currently, researchers are comparing the outcomes of patients who had the BEAR procedure with those of patients who had a traditional ACL reconstruction,” says Dr. Skendzel. “Patients will be evaluated for postsurgical knee stability and muscle strength. I always want to offer my patients the best and most effective treatment options available, so I will be following these trials closely, although the BEAR procedure is not mainstream at this time.”

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  • Jack Skendzel, M.D.

    “An active lifestyle requires superior physical function, and I understand that my patients have exceptionally high standards for their performance and joint health. My goal is to return patients to optimal function so that they can continue to perform and master their personal athletic goals.”

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