Oregon Health & Science University Health is the first system in Oregon to provide an innovative repair for a common athletic injury involving a torn anterior cruciate ligament, or ACL.
The technique involves repairing the torn ligament by enticing it to grow back together again.
Known as Bridge-Enhanced ACL Restoration implant, or BEAR, the technique involves the use of an implant injected with the patient’s own blood to form a bridge between torn ends of an ACL. The collagen implant enables the body to heal the torn ligament by protecting it from the harsh environment within the knee joint. The implant is resorbed by the body, usually within eight weeks.
The technique was approved by the Food and Drug Administration in late 2020 and has been used in a handful of patients at OHSU, beginning with the first case in Oregon this past February.
“ACL reconstruction is one of the most common procedures in sports medicine,” said Jacqueline Brady, M.D., an associate professor of orthopaedics and rehabilitation in the OHSU School of Medicine. “There’s an epidemic of it, especially among young athletes.”
Brady, an orthopaedic surgeon who also serves as head team physician for Portland State University athletics, said she averages about two ACL surgeries per week.
She said the new BEAR technique is especially promising for adolescents and young adults who seem to regain function sooner than they do with reconstruction. In reconstruction, surgeons extract tissue from elsewhere in the patient’s body or that of a cadaveric donor, most often from the tendons around the knee, and use it to rebuild the torn ligament.
“It’s a ‘rob Peter to pay Paul’ situation,’” said Kimberly Hall, M.D., an orthopaedic surgeon with Hillsboro Medical Center, an OHSU partner, who in February collaborated with Brady on the first BEAR surgery in Oregon.
In contrast, the BEAR technique preserves the patient’s tendons, avoids the higher risk of failure associated with using a donor tendon, and uses the body’s own healing power.
“All things being equal, we want to restore what nature provided you,” Hall said.
‘I can feel the growth every day’
Kirsten Dodge was skiing at Mount Hood in April when she made a turn and felt the telltale pop in her knee. She recalled the first surgeon she saw recommending reconstructing the ACL using a graft from her hamstring.
Wary of giving up function in her hamstring while still in her 20s, she sought another opinion. Through her own research, she discovered the BEAR technique. She asked her clinician for a referral to Brady, who answered her questions about the procedure and how it would work in her case. She weighed the fact that she would have to stay completely off the knee for four weeks.
“Meeting with Dr. Brady and the whole team at OHSU, they really put me at ease,” she said. “After talking with her, I thought it has pros and cons — the con being that it’s new. But I trust her, and I trust what she’s telling me.”
She decided to go with the BEAR technique and had the procedure on May 16 at OHSU. Four months later, she is steadily regaining full function as the ligament seals together and heals.
“I can feel the growth every day,” she said. “I can feel my muscles getting stronger and my body trusting my knee more and more.”
Brady has taken on a role speaking to other clinicians about the procedure on behalf of the technique’s developer, Miach Orthopaedics. Although the results are promising for the patients so far, Brady said it will take several more years to gauge whether the technique holds up as well as standard ACL reconstruction in randomized trials, especially for college and professional athletes who want assurance before trying something new.
“The goal is to be able to get them back to being able to use the knee to cut and change direction,” Brady said.
Brady has completed six of the BEAR procedures so far.
For Dodge’s part, she’s quite happy in her choice and already looking forward to getting back on the slopes. First, though, she’ll test herself backpacking through the Northwest.
“I’ve never looked back,” she said.