For Your Consideration: Bridge Enhanced ACL Restoration (BEAR): Why, How, and When

Reconstruction of the anterior cruciate ligament (ACL) has been the gold standard for complete rupture for nearly 40 years. During this journey, variations on technique, rehab, and graft selection have been points of discussion. With the explosion of biologic augments currently seen in orthopedics, a paradigm shift of reconstruction to potential repair and/or restoration has begun. The bridge enhanced ACL restoration (BEAR) procedure provides the ability to perform primary repair of the acutely torn ACL’s via utilization of a proprietary protein based scaffold. Many promising benefits have been shown from early clinical data, including potentially decreasing risk of osteoarthritis, decreased donor site morbidity, and higher success rates in the subset of patients that fail ACL restoration verses those that fail ACL reconstruction. Nevertheless, restoration has potential drawbacks and requires proper patient identification. As the implant has moved from research to commercialization, many questions still exist regarding why, how, and when to use the BEAR implant for injured patients. This manuscript aims to provide a broad overview of these questions and provide clarity based upon initial experiences.