Bridge Enhanced ACL Restoration (BEAR) Implant
Newswise — HACKENSACK, NJ — Orthopedic surgeons at Hackensack University Medical Center performed the first 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.
"The BEAR Implant is the first device developed to help a person’s ACL to heal on its own," explained Hackensack University Medical Center orthopedic surgeon Amit Merchant, MD, who performed this procedure as well as a second BEAR operation with orthopedic surgeon Yair David Kissin, MD. "This approach offers an alternative to conventional ACL reconstruction which uses a tendon from another part of the patient’s body. That can leave a patient with pain where the tendon was retrieved." Such "autografts" are usually tissue taken from the patellar tendon, quadriceps tendon, or hamstring.
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." She sat out the rest of the game, believing it might be a muscle sprain.
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 Dr. Merchant, who had treated Kelis in 2021 for a broken ankle. An MRI confirmed she had torn her ACL.
Her options included two to three months of physical therapy, but without surgical treatment, she would need to wear a brace every time she played soccer—something she was not interested in doing. Then Dr. Merchant told her about the BEAR Implant. "I thought it sounded super cool," said Kelis. She didn’t like the idea of traditional ACL reconstruction, which would have been done using a piece of her own patellar tendon, and she wanted to do all she could to increase her chance of playing Division 1 soccer in college.
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.
"I feel pretty good knowing I’ll have my own ACL back," noted Kelis, who would like to pursue a career in health care. "It was really cool learning about this innovative procedure. I’m so grateful I was able to have it and that it will let me get back to my sport."
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%," added Dr. Merchant. "The BEAR Implant is another example of our leadership in orthopedics and our commitment to offering the most advanced treatments to the people of New Jersey and surrounding areas."
The BEAR Implant is indicated for people with a torn ACL who are skeletally mature (bones have stopped growing). For more information about orthopedic care at Hackensack University Medical Center or to make an appointment, call 844-HMH-WELL.
ABOUT HACKENSACK UNIVERSITY MEDICAL CENTER
Hackensack University Medical Center, a 803-bed nonprofit teaching and research hospital, was Bergen County’s first hospital founded in 1888. It was also the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence, receiving its sixth consecutive designation from the American Nurses Credentialing Center. The academic flagship of the Hackensack Meridian Health network, Hackensack University Medical Center is Nationally-Ranked by U.S. News & World Report 2022-2023 in four specialties, more than any other hospital in New Jersey. The hospital is home to the state's only nationally-ranked Urology and Neurology & Neurosurgery programs, as well as the best Cardiology & Heart Surgery program. It also offers patients nationally-ranked Orthopedic care and one of the state’s premier Cancer Centers (John Theurer Cancer Center at Hackensack University Medical Center). Hackensack University Medical Center also ranked as High-Performing in conditions such as Acute Kidney Failure, Heart Attack (AMI), Heart Failure, Pneumonia, chronic obstructive pulmonary disease (COPD), Diabetes and Stroke. As well as High Performing in procedures like Aortic Valve Surgery, Heart Bypass Surgery (CABG), Colon Cancer Surgery, Lung Cancer Surgery, Prostate Cancer Surgery, Hip Replacement and Knee Replacement. Named to Newsweek’s World’s Best Hospitals 2023 list, Hackensack University Medical Center is also the recipient of the 2023 Patient Safety Excellence Award™ by Healthgrades as well as an "A" Hospital Safety Grade from The Leapfrog Group. This award-winning care is provided on a campus that is home to facilities such as the Heart & Vascular Hospital; and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion, which houses the Donna A. Sanzari Women’s Hospital and the Joseph M. Sanzari Children’s Hospital, ranked #1 in the state and top 20 in the Mid-Atlantic Region in the U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, the children’s nephrology program ranks in the top 50 in the United States. Hackensack University Medical Center is also home to the Deirdre Imus Environmental Health Center and is listed on the Green Guide’s list of Top 10 Green Hospitals in the U.S. Our comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development. The hospital has embarked on the largest healthcare expansion project ever approved by the state: Construction of the Helena Theurer Pavilion, a 530,000-sq.-ft., nine-story building, which began in 2019. A $714.2 million endeavor, the pavilion is one the largest healthcare capital projects in New Jersey and will house 24 state-of-the-art operating rooms with intraoperative MRI capability, 50 ICU beds, and 175 medical/surgical beds including a 50 room Musculoskeletal Institute.
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