Hackensack University Medical Center Performs Innovative BEAR Procedure in New Jersey for ACL Reconstruction

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.

"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.