When South African mom Mari Erasmus’ son tore his anterior cruciate ligament (ACL) while playing rugby seven years ago, she was determined to find the best treatment option for him, and it was during her research that she discovered the BEAR Implant. Unfortunately, her son did not qualify for the novel implant at the time, but her efforts paid off when 52-year-old Mari needed treatment for the same injury. In April 2022, Mari became the first international patient to travel to the U.S. to receive the BEAR Implant.
We chatted with Mari and her orthopedic surgeon, Dr. Charles Gatt of University Orthopaedic Associates in Somerset, New Jersey, about why she selected the BEAR Implant, her unique rehab experience and how she’s been feeling since returning to hiking, one of her favorite pastimes.
Q: How did you tear your ACL?
Mari: I tore my ACL when I slipped on a leaf while playing tennis. When my racket fell to the ground, I wasn’t sure if the popping sound came from the racket, but I immediately knew there was a chance I tore my ACL given my experience with my son. I decided to go to the doctor because I couldn’t walk properly. Not only was I in a lot of pain, but I had an extremely swollen knee. My ACL tear was then confirmed with an MRI. I was very sad because I couldn’t believe it happened to me after the trauma of seeing my son struggle to recover from his injury and ACL reconstruction (ACLR).
Q: How did you learn about the BEAR Implant? What made you decide it was the right choice for you?
Mari: When my son tore his ACL playing rugby at the age of 14, I researched all the treatment options available for him. The doctors said he could get either a traditional ACL reconstruction surgery or live without his ACL. These options were terrifying for him because he was a dedicated athlete. If he got ACL surgery, he would either have to use his hamstring or donor tissue. He did not want to use his hamstring because he was a 200m sprinter and wanted his hamstring tendons to be intact for competing as a track athlete; and using donor tissue would come with a risk of disease transmission. Through my research, I learned about the BEAR Implant and all its benefits, but unfortunately, he did not qualify for the surgery. Initially, we opted not to undergo ACL surgery because he was young, and his growth plates were still open. But after struggling for three years, we changed our minds. Post ACL surgery, he continued to deal with ongoing complications, which reinforced my resolve to take a different path for my surgery.
When I tore my ACL, I knew exactly what to do. I just did not feel that reconstruction was the right choice for me. I didn’t want to lose part of my hamstring or patellar tendon, and to me, getting ACL reconstruction was like killing a mosquito with a bazooka. I was determined to find a physician in the U.S. willing to treat my injury with the BEAR Implant—despite the fact that I was located halfway around the world. I wasn’t having much luck reaching out to doctors on my own, so I reached out to Miach Orthopaedics, the developers of the BEAR Implant, and they were very helpful and eventually connected me with Dr. Gatt.
Q: As an international patient, did you experience any challenges after you decided to come to the U.S. to get the BEAR Implant surgery?
Mari: Before moving forward, I had to sort through a number of hurdles, including getting a U.S. visa by submitting a letter from Dr. Gatt’s office to the U.S. government, which noted that my surgery was medically necessary and unavailable in South Africa. I was on a waitlist to get my visa and spent many nights looking for appointment cancellations that I could book. I also made arrangements with Dr. Gatt’s office to pay out of pocket and deal with my South African health insurance separately.
Q: Why was Mari a good candidate for the BEAR Implant? What made you comfortable taking her on as an international patient?
Dr. Gatt: Mari is a very healthy and athletic patient and fitness is a big part of her life. Clinically, her injury was a femoral avulsion, so a good stump on the tibia made her a good candidate for the BEAR Implant. Her son and some of his friends had ACLR and their recoveries had not gone as well as she thought they should have. She was reluctant to consider ACLR and was very interested in getting the BEAR Implant based on her own research. I reviewed Mari’s MRI via a telemedicine visit and agreed to help her after she committed to spending an extended period of time in the U.S. for surgery, recovery and follow up.
Q: Can you tell us more about rehab?
Mari: After surgery, I started the recovery process through a physical therapy protocol that included going to see a physical therapist three times in person at Dr. Gatt’s office and then followed by seeing a physical therapist located near my home in South Africa. I had ongoing telemedicine appointments with Dr. Gatt to ensure my recovery was on track. I wasn’t able to travel back to the U.S. for in-person follow up appointments due to the weak South African currency. My South African physical therapist kept in contact with both Dr. Gatt and Miach Orthopaedics to ensure I was following the proper protocol.
Overall, I found rehab to be difficult given I didn’t have access to as many in-person sessions while in South Africa. My insurance didn’t cover the cost of rehab, so after two months, I had to do it on my own and be more committed. I read through the protocol to understand what to do at each stage and even though I watched videos, it was sometimes difficult to put it into real practice. My goal during rehab was to continue to do the exercises until they became easier and easier. I sometimes worried about what the normal progression was since I was on my own, but Dr. Gatt always put my mind to ease. Every week, I realized I could take it further and little by little, I could see the improvement in balancing and bending the knee. I started with getting back to afternoon walks and by 10 months post-surgery, I was able to return to hiking.
Dr. Gatt: Mari did a great job of being self-motivated with her rehab. She updated me on her progress via telemedicine, and her physical therapist in South Africa also communicated with the physical therapist on my team.
Q: Can you tell us about your return to sport – hiking in particular?
Mari: I first returned to hiking and climbing mountains in February 2023. I moved to Cape Town, where Table Mountain and Lion’s Head are the two main hiking spots. I decided to start by climbing Lion’s Head, the smaller mountain. I wasn’t scared and thought to myself, “it’s going to be fine.” As I climbed up using the staples as a guide, one of my feet couldn’t find the staple and I started to wonder if my knee would hold and what if something happened. I ended up climbing all the way to the top and didn’t think twice. In fact, I didn’t even know which knee was operated on because they both felt really similar. After finishing the Lion’s Head hike, I decided to hike Table Mountain next. The first time I climbed Table Mountain, I hiked to the top and took the cable car down. I recently hiked all the way up and all the way down on my own. It’s typically a seven-to-eight-hour hike round-trip, but I completed it in four hours. It’s a strenuous course, but very worth it. It was stunning to see the world, the beaches and the town from above.
Q. What are some of your personal goals in terms of physical activity?
Mari: I hike Table Mountain or Lion’s Head at least once a month. There are so many mountains I want to climb. Every afternoon, I walk for one to two hours on the promenade near my house. I practice walking in thick sand so I can build more muscle and continue to go further and further. I haven’t been back to playing tennis yet – my plan is to join the tennis club in Cape Town this summer.
Q. What did your family and friends think about you getting the BEAR Implant?
Mari: My family was very excited that I was able to receive the BEAR Implant because they knew I had been keeping my eye on it ever since my son’s injury. My friends were also optimistic about the procedure. Some had had traditional ACL surgery and had accepted they couldn’t do certain activities. Being able to be mobile as long as possible is important to me. My son has been really excited to see the progress I’ve made. In fact, when I’m on my knees sometimes reaching for things in the cabinet, he still can’t believe I’m able to bend my knee and kneel down without issues.
Q: Mari was the first international patient to get the BEAR Implant in the U.S. What made you comfortable taking on her case?
Dr. Gatt: With the advancement of telemedicine, I felt comfortable taking Mari on as an international patient because I got to know her via our virtual visits. In my opinion, if it’s medically necessary and if these patients are motivated and can meet the requirements of in-person care when needed, the BEAR Implant can definitely be an option for them.
I understood she had the right motivation to pursue the BEAR Implant, and healthcare availability around the world is different. We have a good healthcare system and can help people who might not be able to get similar treatment in their country. It feels good to be able to fill that gap. In addition, because I take care of Division 1 athletes, I have operated on a number of international students who play soccer and basketball, among other sports. I had experience communicating with their parents overseas to let them know what they would be undertaking and supporting them through the process.
Q. Has your decision to get the BEAR Implant changed your life or impacted your daily life in any way?
Mari: I’m definitely confident in my knee. When I see someone who injured their knee, I tell them about the BEAR Implant, but I understand not everyone can go to America to get the procedure. I was really lucky and fortunate that Dr. Gatt made it a reality for me. Without Miach Orthopaedics and Dr. Gatt, I would not be where I am today. I am forever grateful.
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-1114 Rev A 09/2023