For physical therapists, an anterior cruciate ligament (ACL) tear affects more than daily life; it directly impacts the ability to work, demonstrate movement, and support patients through recovery. Advances in ACL treatment continue to change how surgeons approach these injuries, especially for patients whose careers depend on strength, stability, and body awareness.

In this BEAR at Work story, we spoke with Abby Friesen, a physical therapist (PT) who tore her ACL while skiing, about why she chose the BEAR^® (Bridge-Enhanced ACL Restoration) Implant, how her experience has given her more empathy with her own patients and how she’s doing today. We also spoke with her surgeon, Dr. Brian Gilmer, an orthopedic surgeon and knee & sports medicine specialist at the Swift Institute in Reno, Nevada, and the Mammoth Orthopedic Institute in Mammoth Lakes, California, about what makes the BEAR Implant unique and how he applies his philosophy of “repair whenever possible, reconstruct when necessary,” when it comes to treating ACL tears.

Q: How did you tear your ACL?

Abby: I had been skiing all season, and it was the best powder day of the year. As I was skiing down the run, I made a turn and fell. It felt like it happened in slow motion; I heard a pop and knew immediately that I tore my ACL. It hurt really bad, and 10 days later, the MRI showed that in addition to my ACL tear, I had torn my lateral meniscus, sprained my medial collateral ligament (MCL) and had bone bruising on everything in the area.

Q: How did you learn about the BEAR Implant and decide it was right for you?

Abby: I had only had experience with patients who underwent traditional ACL reconstruction (ACLR) and was initially considering getting a patellar tendon or quad graft. However, when I went to see Dr. Gilmer, he introduced the concept of the BEAR Implant. I was skeptical at first because the benefits seemed almost too good to be true. The idea that my ACL could heal itself without requiring a donor site and not experience comorbidity from not having to take from another part of my body was appealing to me. The BEAR Implant surgery was less invasive and as a physical therapist, I believe that the less invasive option is often optimal. I was very confident after watching all the patient testimonials and how-it-works videos. After reviewing all the research and data, I decided to move forward.

Q: What, in your opinion, is most notable about the BEAR Implant?

Dr. Gilmer: The BEAR Implant’s lack of donor site morbidity is unique, especially the way that quad muscle rehab does not fall so far behind. People preserve their strength better than with ACL reconstruction and typically do not have as much atrophy. Everyone who undergoes rehab following ACL surgery has atrophy, to a certain extent it’s unavoidable. However, with early repair and rehab, atrophy can be less for BEAR Implant patients compared to traditional reconstruction. 

As surgeons, we value stability and an intact graft, but patients value a normal feeling knee that is strong. Also, the lower amount of swelling and the reduction of opioid needs that I have seen. As we all push forward toward opioid-free surgery I think doing a less invasive surgery that is less painful has appeal, and I look forward to more data that will bear this out. For now, I see patients in my practice who have a BEAR have less pain.

Q: Why was Abby a good candidate for the BEAR Implant?

Dr. Gilmer: One unique feature about Abby is that she is a physical therapist. The early BEAR Implant rehab protocols were a bit more restrictive when it comes to range of motion and gradually, the protocols have been revised to be simpler. In the early stages while protecting the repair, it is helpful to have someone like Abby who has good healthcare literacy and understanding of the rehab protocol.

Abby has great body awareness and so I think the benefit for someone like her is she is more likely to be aware of a little stiffness or some swelling that other people may not. I think she has seen the donor site morbidity of traditional ACL grafts and understood and desired to avoid that. She had an acute tear, with a favorable amount of ACL stump remaining and was a good rehab candidate. That is the recipe for a good outcome.

Q: How has the BEAR Implant technology impacted how you treat ACL tears?

Dr. Gilmer: I look to repair more often than I did before. And my philosophy has been, repair whenever possible, reconstruct when necessary. It has also given me a better appreciation for what patients value in their recovery.

Q: How did rehab compare to what you expected as a physical therapist?

Abby: The first four weeks were really slow. Some of the precautions in the initial stages are more conservative for good reason. I experienced some atrophy, but found I was able to achieve quad activation more quickly than traditional ACLR patients and patients who’ve had different knee surgeries. Once I started doing more close chain progression activities, the movements were not as hard as I thought they would be. Week after week, my strength came back and my surgical side is now nearly comparable to my other side in muscle bulk.

It has been a pretty smooth process overall, and going through the activities has helped me relate to my patients. Since I’m a very active person, I had a tough time taking it easy. Prioritizing my rehab felt like taking on a part time job. I am lucky to have great support from my family and my boyfriend, and they helped give me perspective that progress doesn’t just happen day to day, but over months and longer stretches of time.

Dr. Gilmer: Her recovery was very standard, and I didn’t hear much from her after that initial three months, which for surgeons is a good thing because with someone like her, she would tell me if something was off.

Q: How did your rehab go compared to other BEAR Implant patients you have helped through ACLR rehab? 

Abby: Throughout my recovery, I felt like I was ahead of where my ACLR patients typically are at and hitting my landmarks early. I regained my range of motion and muscle activation pretty quickly, and a lot of my ACLR patients haven’t even gone back to running at the 5-6 month mark – I was able to start that return at 3 months. I also haven’t had the same level of pain as them. While I did experience some acute and surgical pain, this was limited to the first couple days, while soreness and aches persisted over the first couple of weeks. I have found that my patellar tendon graft patients sometimes experience tendonitis and more acute pain for a while, which I was able to avoid. I was also able to return to the gym pretty early on to work on strength and endurance.

Q: When were you able to return to work as a physical therapist? How do you rely on your knee at work?

Abby: I went back to work at 2 weeks post-surgery. I needed to be able to drive first, since my knee was limited to 45 degrees flexion during those first 2 weeks. My clinic was flexible with me and allowed me to slow my schedule down. When I first went back, I worked 10-hour days between two tables so I could just turn from one table to the other. I was mainly nervous about being on my feet for longer than I had been and sitting with my knee bent to 90 degrees. I had some expected soreness, but was surprised with my tolerance for sitting and standing. For my mental health and the fact that I like being a physical therapist, I didn’t feel like I needed to be out of work longer than necessary. I needed some help demonstrating exercises and getting equipment in the first few months, but I found that patients and techs were willing to help and support me.

During my 10-hour workdays, I have to engage in a variety of physical activity. I have to be able to squat to help patients transfer and demonstrate exercises. My knee has to be stable and balanced to guard and keep patients safe. I also need to be able to walk all day for long periods of time to manage my patients over a large clinic space.

Dr. Gilmer: I clear people for office work around 2 weeks, but they are limited and it depends on each individual. I find that most patients could work from home on a computer within 3-4 days and be back in a traditional work setting in 3-4 weeks. For heavy duty work like construction, it could be as long as 3-4 months – a return-to-work timeline really depends on the person and their job demands. It helps to have proactive patients like Abby who are invested in their recovery. They are motivated to be involved in their own recovery and that motivation that often brought them to be interested in the BEAR Implant also makes them great patients who get great results.

Q: How does return-to-work timing differ between the BEAR Implant and ACL reconstruction?

Dr. Gilmer: The biggest thing on the front end is eliminating the need for opioids that are often prescribed for ACL reconstruction. This allows people who get the BEAR Implant to do cognitive work like computer work from home within a couple of days. With more physical jobs, patients are limited by pain and swelling but also by muscle weakness specifically in the quadriceps. This can limit their ability to walk and get back to work even just in an office setting.

Q: How does your BEAR knee feel today?

Abby: My BEAR Implant knee continues to feel stronger and better every month. I am now able to demonstrate all exercises confidently at work and ensure patient safety, knowing my knee is strong. Outside of work, I am back to running, hiking, climbing, biking, and swimming. I enjoyed snow shoeing this past winter while I avoided skiing to work on further strengthening my knee. I am very happy with my BEAR Implant.

Q: How has getting the BEAR Implant changed your life or impacted your daily life?

Abby: Although I sometimes worry about retearing my ACL, I have confidence in my BEAR Implant knee. I’m giving it time and space to fully heal, but I don’t have to be afraid to try things. Having had experience with the before and after of surgery, I have so much empathy for my patients I work with at the Swift Institute. I understand them better and have been able to share tips that worked for me after surgery in terms of pain control, icing and even positioning for sleeping. Right now, I have a lot of knee replacement patients and those that have trouble with range of motion, I’ve been recommending wall slides. My experience has helped me become a physical therapist that is more in tune with what my patients need and are going through.

Q: Would you recommend the BEAR Implant to others?

Abby: Definitely. If it’s an option, I would recommend it. It’s less invasive, less hard on your body long term, and my recovery has been a little quicker and less painful than some of the ACLR patients I’ve seen. I haven’t had a chance to work with a BEAR Implant patient for their rehab yet, but it is something I am really looking forward to and am passionate about.

Learn more about the BEAR Implant and find a surgeon

The BEAR Implant is available across the U.S. Learn more about the BEAR Implant or find a surgeon in your area. If you’re a parent considering the BEAR Implant for your child, click here for more information. If you’re a BEAR Implant patient and would like to share your story, click here.

The BEAR Implant from Miach Orthopaedics was approved by the U.S. Food and Drug Administration in December 2020. It is indicated for adults, adolescents and children with a complete or partial rupture of the ACL, as confirmed by MRI. Patients must have an ACL stump attached to the tibia to construct the repair. Children with open physes must have sufficient bone in the femoral and tibial epiphyses on either side of the intended tunnel locations to avoid disruption of the growth plates. In patients 14 years and older who have an ACL injury with concomitant knee injuries, ACL restoration with the BEAR Implant reduces the risk of developing post-traumatic knee osteoarthritis (Kellgren-Lawrence grade 2 or higher), at 6-years post-surgery, compared to ACL reconstruction (ACLR) surgery using hamstring tendon autograft.

It is important to follow the BEAR Implant physical therapy program. Your surgeon can explain the program details.

Be sure to discuss your individual symptoms, diagnosis and treatment with your surgeon. The BEAR Implant has the same potential medical/surgical complications as other orthopedic surgical procedures, including ACL reconstruction. These include the risk of re-tear, infection, knee pain, meniscus injury and limited range of motion.

Visit miachortho.com for complete product information, including Instructions for Use.

ML-1401 Rev A 5/2026