Bridged-Enhanced ACL Restoration: An Adolescent Case Report with 18-Month Follow-up

Introduction Historically, the surgical management of anterior cruciate ligament (ACL) ruptures has focused on reconstruction using allografts and autografts. The new bridge-enhanced ACL repair (BEAR) employs biological augmentation to repair the ACL using a bovine collagen-based implant, by supporting cell migration and proliferation. This case report presents an 18-month follow up of a high school athlete who underwent BEAR surgery following a high-grade partial ACL tear. Case Report and Surgical Technique A 15-year-old male high school athlete experienced a non-contact knee injury, and examination revealed joint effusion, joint line tenderness, along with positive Lachman’s and McMurray’s tests. The MRI showed a high-grade partial ACL tear with an intact tibial stump and open physes, satisfying the criteria for BEAR. Femoral tunnels were established, and the ACL stump was whipstitched. A BEAR scaffold, prepared with 20 cc of whole blood, was then secured between the femoral and tibial footprint, preserving the native ligament. Outcome Rehabilitation adhered to a BEAR-specific protocol that included five distinct phases for recovery. At 6 months, the patient demonstrated full range of motion and symmetric quadriceps and hamstring strength. MRI at 7 months confirmed graft integrity and biologic healing. At 1 year, the patient had returned to competitive football and began preparing for basketball, reporting high satisfaction with the procedure. Conclusion This case demonstrates a successful BEAR use in a pediatric athlete, resulting in complete functional recovery, MRI-confirmed healing, and a return to competitive sport after one year. The BEAR may be a feasible alternative to ACLR in selected athletes and ideal candidates, though larger studies are needed to confirm long-term outcomes.