Hackensack University Medical Center Performs Innovative BEAR Procedure for ACL Reconstruction

What You Need To Know

• Orthopedic surgeons at Hackensack University Medical Center performed the Bridge Enhanced ACL Restoration (BEAR) Implant operation to reconstruct the injured knee ligament of a 15-year-old soccer player.
• The BEAR Implant is an innovative treatment that promotes the body’s own healing processes to join the ends of a torn anterior cruciate ligament (ACL), one of the most common sports injuries.

Initial X-Ray Showed Nothing Suspicious

The patient, Kelis Guzman, is a 10th grader from Hasbrouck Heights, New Jersey who plays on the New Jersey Crush Girl Academy-level soccer team as well as in the Elite Clubs National League (ECNL)—a more intense level of play. At an exhibition game in February, after executing a side tackle, she felt her left knee pop and click when she stood up. "It wasn’t painful, but it felt very unstable," she recalled. "Something was definitely wrong." A visit to a local emergency room showed nothing suspicious on an x-ray, so the doctor sent her home. After a few days, it hurt to flex her leg and she had limited range of motion. Her mother, Karin—a Patient Access Specialist at Hackensack University Medical Center—took her to see Amit Merchant, M.D., who performed this procedure as well as a second BEAR operation with orthopedic surgeon Yair David Kissin, M.D. An MRI confirmed she had torn her ACL.

An Alternative To Conventional ACL Reconstruction

The synovial fluid that acts as a lubricant in the knee also prevents the formation of blood clots that are vital for healing, so a torn ACL will not heal by itself. BEAR is a spongy collagen implant that is infused with a patient’s blood. The surgeon positions it between the two torn ends of a ruptured ACL during arthroscopic outpatient surgery. The implant is designed to hold and protect the patient’s blood in the gap between the ends of the ACL and promotes the formation of a clot. Within eight weeks, the BEAR Implant is resorbed and replaced with a person’s natural cells, collagen, and blood vessels. The new tissue continues to rebuild itself and strengthen over time. During Kelis’ operation, the surgical team removed a small sample of her blood while she was in the operating room. Working through very small incisions, Dr. Merchant first sutured the torn ends of her injured ACL. He then saturated the BEAR Implant with her blood and positioned it within the gap. She went home the same day using crutches and was able to put weight on her left leg. She started physical therapy a week later and within six weeks was up to three weekly sessions. Her range of motion is returning well, and she should be able to go back to playing soccer by December, having allowed her body and the BEAR Implant to heal her injured ACL.

Restores Patient's Native ACL

In addition to promoting natural healing, the BEAR Implant operation does not involve removing the nerve endings in the ACL that give an athlete proprioception—the ability to feel where one is moving in space, and a critical aspect of preventing injury. Conventional ACL reconstruction using an autograft removes the original ACL nerve endings and may reduce proprioception, so leaving those nerves in place could potentially give an athlete a better sense of how to move efficiently to prevent injury.

"This technique is a way to restore a patient's native ACL. It's not just sewing two ends of the ligament back together, but rejuvenating the healing process and getting a patient back to 100%."  -- Dr. Merchant