Future Prospects for Bridge Enhanced ACL Repair in ACL Injury Treatment

Abstract

Anterior cruciate ligament (ACL) is one of the four most important ligaments in human knee, and ACL tears are one of the most commonly seen injuries among common ligamentous knee injuries. Severe ACL tears usually require surgical treatment for complete recovery. In the past decades, ACL reconstruction (ACLR) has been the gold standard by its high success rate and easiness on surgical application. However, ACLR sacrifices native ligament tissue and may lead to donor-site morbidity and delayed neuromuscular recovery. The new Bridge-Enhanced ACL Repair (BEAR) technique introduces a biologically augmented approach that keeps the patient’s native ligament tissue and proprioceptive fibers while restoring ligament integrity. Histological analyses have proven ligament function regeneration sign on BEAR treated patients. In randomized controlled and prospective cohort studies, BEAR treated patients show better IKDC and KOOS improvements compared to patients treated with traditional ACLR. Clinical reports further validate BEAR’s potential to reduce postoperative complications and enhance neuromuscular function. This review aims to synthesize the biological rationale, operative evolution, clinical effectiveness, and remaining challenges of BEAR in contemporary ACL care.