Dr. Garcia’s BEAR ACL repair technique with an Internal Brace

This video, titled "Dr. Garcia’s BEAR ACL repair technique with an Internal Brace," outlines a cutting-edge procedure designed for a young, active patient. Instead of a traditional ACL reconstruction—which completely replaces the torn ligament with a tendon graft—this technique uses the BEAR (Bridge-Enhanced ACL Restoration) bovine collagen implant combined with an internal brace to preserve and regrow the patient's native ACL.

The surgeon emphasizes that this procedure requires excellent native tissue quality, needing at least 1.5 centimeters of healthy ACL stump to work.

The primary surgical steps demonstrated are:

• Debridement and Microfracture: The surgeon cleans away the scar tissue around the torn ACL and performs a small notchplasty to improve visualization. The femoral wall footprint is microfractured, creating controlled tiny punctures that allow bone marrow and healing factors to seep directly into the joint space.
• Tunnel Drilling: A 4.5mm femoral tunnel is drilled straight through the femur to accommodate a fixation button, and a smaller tunnel is created through the tibia using a specialized guide.
• Stitching the ACL Stump: High-strength tape sutures are passed through the native ACL tissue stump in a modified pattern (including a loop stitch near the weaker end of the tissue) to achieve a high-strength grip on the remnant ligament.
• Threading the Construct: The surgeon configures an EndoButton loaded with internal brace fiber tape. The suture limbs from the repaired ACL stump are threaded through the button mechanism in the opposite direction. The button is then passed up and flipped securely on the outside of the femur.
• Preparing for the BEAR Implant: The surgeon creates a small 5-centimeter arthrotomy (incision) to access the joint directly. The fluid irrigation is completely turned off, and the joint space is dried thoroughly, as fluid would wash away the blood clot essential for the BEAR implant.
• Implant Preparation and Insertion: The BEAR collagen sponge (which has a hard side and a soft side) is threaded onto the internal brace tapes using a needle. The implant is saturated with 20 cc's of the patient's own whole blood. Just as the sponge begins to soften, it is pushed into the joint.
• Final Fixation and Tensioning: The fiber tapes are pulled downward from the tibia, drawing the blood-soaked BEAR implant snugly into the femoral notch. Concurrently, the ACL repair sutures are pulled upward, drawing the native ACL stump directly into the implant. With the knee held in full extension, the internal brace is anchored to the tibia bone using a SwivelLock screw. Finally, a knot pusher is used to tie multiple half-hitches at the femoral button, securely approximating the native ACL into the sponge where it can naturally heal and regenerate.