When someone tears their ACL, the first question is usually simple: How fast can I get back to doing the things I love? But when choosing ACL surgery, there’s another important question to consider: What will your knee be like 10 or 20 years from now?

An ACL injury doesn’t just affect the next season. It can also influence the long-term health of your knee joint, including the risk of developing post-traumatic osteoarthritis (PTOA), a form of arthritis that can appear years after the injury. That’s why surgeons and researchers increasingly talk about “playing the long game” when discussing ACL treatment options.

For some patients, that conversation now includes an option designed to restore the torn ligament rather than replace it: the BEAR_^® (Bridge-Enhanced ACL Restoration) Implant.

ACL Surgery and Long-Term Knee Health

ACL tears are one of the most common knee injuries among athletes and active people. For decades, the most widely used surgical treatment has been ACL reconstruction, which replaces the torn ligament with a tendon graft taken from your body or from a donor.

ACL reconstruction can restore stability and allow many patients to return to sports. However, stability alone does not guarantee long-term joint health. Researchers have found that many patients who undergo ACL reconstruction later develop PTOA. Studies suggest that about half of patients show signs of osteoarthritis within 10 years of ACL reconstruction.

For younger athletes, that timeline can be surprising. Someone who tears their ACL in high school could begin experiencing arthritis symptoms while still in their twenties.

Orthopedic Surgeon Dr. Jocelyn Wittstein says this long-term risk is one of the reasons surgeons are paying closer attention to arthritis after ACL injury.

“The uncomfortable truth is that some of our patients develop arthritis at a young age soon after ACL reconstruction,” Dr. Wittstein says. “I am deeply worried about teenagers having arthritis when they are 25.”

For many patients and parents, that possibility changes how they think about ACL surgery options.

Why ACL Injuries Can Lead to Arthritis

The risk of osteoarthritis after an ACL tear begins at the moment the injury occurs. When the ligament tears, trauma triggers inflammation inside the knee joint. Over time, this inflammatory response can damage cartilage and other structures that help the joint move smoothly.

ACL reconstruction restores mechanical stability but does not directly address the biological processes triggered by the injury. Because of this, many orthopedic specialists now discuss ACL treatment through a joint preservation lens, considering how treatment choices may affect the knee years or even decades later.

What the BEAR Implant Does Differently

The BEAR Implant takes a different approach to ACL surgery. Instead of replacing your torn ligament with a graft, the procedure is designed to help the body heal your own ACL.

During surgery, the surgeon places the collagen implant between the torn ends of the ACL. The implant is then saturated with a small amount of your blood, creating an environment that supports natural ligament healing.

As the ACL heals, the BEAR Implant is resorbed by the body. Because the native ACL is preserved, the knee maintains its natural structure.

Learn more about how the technology works:

Clinical Data on Osteoarthritis Risk

In January 2026, the U.S. Food and Drug Administration approved an updated label for the BEAR Implant based on clinical data demonstrating a significantly lower risk of osteoarthritis compared to ACL reconstruction.

In the BEAR I and BEAR II clinical trials, researchers evaluated patients six years after surgery and found:

• 5.7% of patients treated with the BEAR Implant showed signs of osteoarthritis
• 33% of patients treated with ACL reconstruction showed signs of osteoarthritis

This represents roughly a six-fold lower rate of osteoarthritis among BEAR Implant patients in those studies. While research continues, these findings suggest that restoring the native ACL may help support better long-term knee health.

Read more about the announcement: https://miachortho.com/about-us/press/2026/fda-approves-updated-label-for-miach-orthopaedics-bear-implant-to-include-significantly-lower-risk-of-osteoarthritis

How Surgeons Are Rethinking ACL Treatment

For many years, ACL surgery success was measured primarily by two outcomes: whether the knee was stable and whether the patient returned to sports. Those outcomes remain important, but surgeons increasingly recognize that long-term joint health should also be part of the decision-making process, particularly for younger patients.

Dr. Theodore Shybut, orthopedic surgeon at the Southern California Orthopedic Institute, says emerging data on post-traumatic osteoarthritis is changing how surgeons think about ACL care.

“Post-traumatic osteoarthritis is an outcome we must now consider – it must inform how we counsel patients considering ACL surgery,” he says. “For many young athletes, the enduring health and function of their knee will ultimately carry far greater significance than a handful of high school sport seasons.”

For someone who tears their ACL as a teenager, the goal is not only returning to play next season. It’s preserving the health of the knee for decades to come.

Playing the Long Game With ACL Treatment

If you’ve torn your ACL, it’s important to talk with your orthopedic surgeon about both short-term recovery and long-term outcomes.

Questions to discuss include:

• What ACL surgery options are available for my injury?
• Am I a candidate for the BEAR Implant procedure?
• How might each treatment affect my knee long term?
• What does recovery look like for each approach?

Not every ACL tear is eligible for BEAR Implant surgery. Your surgeon will evaluate the specific characteristics of your injury to determine the best treatment approach.

Understanding your options helps ensure that your decision supports both your recovery today and the long-term health of your knee.

Key Takeaways

• ACL injuries increase the long-term risk of knee osteoarthritis
• ACL reconstruction stabilizes the knee but replaces the ligament with a graft
• The BEAR Implant restores the patient’s native ACL instead of replacing it
• Clinical trials show significantly lower osteoarthritis rates in BEAR Implant patients compared to reconstruction
• Choosing ACL surgery should consider long-term knee health, not just return to sport

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.

Frequently Asked Questions

Below are answers to some of the most common questions about the BEAR^® Implant and long-term knee health.

What is the BEAR Implant?

The BEAR (Bridge-Enhanced ACL Restoration) Implant is designed to help the body heal a torn ACL instead of replacing it with a tendon graft during ACL reconstruction surgery. The implant, when combined with your blood, creates an environment that supports natural ligament healing.

Is the BEAR Implant different from ACL reconstruction?

Yes. ACL reconstruction replaces the torn ligament with a tendon graft, taken from your leg or a donor. The BEAR Implant helps restore your own ACL, allowing the ligament to heal rather than be replaced.

Does an ACL tear increase the risk of arthritis?

Yes. ACL injuries can increase the risk of post-traumatic osteoarthritis (PTOA), a type of arthritis that develops after joint injury. Research has shown that many patients treated with ACL reconstruction develop signs of PTOA within about 10 years.

Who may be eligible for the BEAR Implant?

The BEAR Implant may be appropriate for patients with ACL tears who still have enough remaining ligament tissue. Your orthopedic surgeon will evaluate imaging and tissue quality to determine whether the procedure is appropriate.

How long is recovery after BEAR Implant surgery?

Recovery timelines are generally similar to ACL reconstruction. Most patients participate in physical therapy and gradually return to sports around 9–12 months, depending on healing progress, strength, and stability.

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-1412 Rev A 04/2026