Jack Holst is a multi-sport athlete, including competing on his high school’s junior varsity track & field team in shot put, weight throw and discus. After injuring his ACL while skiing, he turned to Dr. Marc Pietropaoli (Dr. P), his orthopedic surgeon at Victory Sports Medicine & Orthopedics in Skaneateles, NY, to discuss his options and figure out a way to get back to the sports he loves. We spoke to Jack about getting the BEAR Implant, as well as Dr. P and Jack’s rehabilitation coordinator Zach Kaplan about his recovery.
Q: How did you tear your ACL?
Jack: I tore my ACL while skiing. While skiing backwards, my ski got caught under the snow and my leg twisted. I heard a loud pop and immediately dropped to the ground. I thought I could still ski back to the lodge, but when my leg buckled, I knew something was wrong. Ski patrol thought I most likely tore my ACL and by the next morning, my knee was really swollen. After getting an X-ray and MRI, I was told I needed surgery because my ACL was torn in half. I was pretty devastated and worried I wouldn’t be able to run or ski again.
Q: How did you learn about the BEAR Implant? Why was it the right choice for you?
Jack: My original plan was to get the traditional ACLR surgery. After speaking with Dr. P, he recommended the BEAR Implant surgery as an option to regrow my ACL. He taught me how it works and because I found it interesting, I decided to give it a shot.
Q: Why was Jack a good candidate for the BEAR Implant?
Dr. P: Jack was a good candidate for the BEAR Implant because he is young, and young people have excellent healing potential. What was particularly interesting about his case was his family was completely bought into the process. Jack’s father underwent an open ACL reconstruction back in the 1980s after a soccer injury and has developed some arthritis since then. He had seen the evolution to arthroscopic ACL reconstruction and now ACL repair/restoration using the BEAR Implant. He and his wife did a lot of research and were very well educated on the topic. They were also my previous neighbors, so we already had their trust.
Q: Can you tell us about rehab?
Jack: The toughest part about rehab was getting the ball rolling while recovering from surgery. It was a painful process at the start, but I focused on being present during my rehab sessions and also practiced the exercises at home. I knew that if I put in the work I needed to, the end result could be better than expected. Although I had ups and downs, it was worth it in the end. After I completed rehab, I saw the regrowth of my torn ACL on an MRI. I was pretty shocked because I thought it would look warped and different. It looked brand spanking new, and I was thrilled.
Dr. P: Jack actually had an interesting incident where he slipped and fell in the shower within the first two to three weeks after his surgery without his brace on. He flexed his knee well past the “recommended” flexion at the time. Although we were a bit concerned, we still elected to continue to follow and rehabilitate him. Jack is an extremely hard worker and did great during rehab. When we performed his MRI at six months, he had one of the best-looking ACL regrowth that we have seen! His subsequent MRIs have looked outstanding as well.
Zach: Jack was always very determined during each rehab session and didn’t leave until he was in a pool of sweat. In Jack’s case, what stood out to me the most was the deficit between his two thigh circumferences. He had a two-inch deficit in the thigh circumference of the leg with the BEAR Implant, which is typically indicative of potential for reinjury. Before we could allow him to progress in rehab, we had to focus on getting his legs balanced, which required Jack to work out a lot.
Jack’s rehab was unique because we used blood flow restriction therapy (BFRT) on him. BFRT allows blood flow into the limb but temporarily occludes blood flow out of the limb, tricking the body to think it is lifting a lot more than it is. This type of therapy really helps to produce growth hormones from the brain and insulin-like growth factor-1 (IGF-1) in the liver. These hormones synergistically worked together to help reduce the chance of re-injury and influenced an environment where Jack could build his muscle back. By the time he was discharged, his thigh circumference on both legs became symmetric. It was a huge undertaking on his part.
Q: Can you tell us about your return to sport experience?
Jack: During my first track meet, I was still holding back a little and not throwing as far as I could in shot put because I didn’t want to put more pressure on my knee. I threw 22 to 24 feet, similar to how I was throwing before I injured my ACL. At my second meet, I started to feel really confident with my knee. Once I decided to trust in my knee, I gave it all I had and threw 36 feet in shot put, far exceeding my personal record.
Q. What have you learned through this process?
Jack: The BEAR Implant gave me a second chance to be able to run and do sports at the level I am now. My dad had traditional ACLR surgery and still has trouble doing physical things I’m able to do. At his age, I will still have a normal ACL, but he has a complicated set-up with screws in both knees. I think getting the BEAR Implant was a more natural way to let my body take its course to heal and regrow my ACL with a little bit of help.
Q: Why do you recommend the BEAR Implant for your young athletes like Jack?
Dr. P: There are so many reasons I would recommend the BEAR Implant for young athletes. We know that if someone tears their ACL, they have at least a 50% chance of developing arthritis within four to five years. For younger patients, if they tear their ACL and undergo an ACL reconstruction, they still have a 50% chance of developing arthritis – but it pushes it out about 12 to 14 years. In a 16-year-old, they end up being 28 to 30 years old when they have a likely chance of developing arthritis. That is extremely young. Early animal research suggests that there could be less risk of arthritis with the BEAR Implant. Long-term clinical studies in humans are underway to assess the impact of the BEAR Implant on osteoarthritis.
Q: What in your opinion is the most notable thing about the BEAR Implant?
Dr. P: Based on my discussions with my peers and looking at social media posts from other surgeons who have performed this surgery, it seems that many of them are performing this procedure on proximal ACL tears. Although patients with proximal tears are definitely great candidates for the procedure, I think we need to get the word out that the ideal candidate for the BEAR Implant is actually someone like Jack with a mid-substance, full thickness ACL tear. We already know that many proximal ACL tears will heal with standard ACL surgery; however, aside from the BEAR Implant, we have zero clinically proven solutions to repair and restore a full thickness, mid substance ACL tear. I think the BEAR Implant is an excellent solution to fill this gap.
Q: What are some of your goals or plans for the future?
Jack: My long-term goal with shot put is to just keep improving my personal record. Aside from sports, I plan to go into the Air Force after graduating from high school. Before my dad blew out both his knees playing soccer, he wanted to enlist in the Marine Corps. It is a dream of mine to be actively serving in the Air Force versus a regular job sitting at a desk. I really want to make my dad proud.
Learn more about the BEAR Implant and find a surgeon
The BEAR Implant from Miach Orthopaedics was approved by the U.S. Food and Drug Administration in December 2020. It is indicated for skeletally mature patients at least 14 years of age with a complete rupture of the ACL confirmed by MRI. Patients must have an ACL stump attached to the tibia to facilitate the restoration.
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 www.miachortho.com for complete product information, including Instructions for Use.
ML-1113 Rev A 10/2023