For professional mixed martial arts (MMA) fighter Ryan Cafaro – a.k.a., “Korean Thunder” – fighting is his livelihood. He discovered MMA during high school wrestling and never looked back, building his entire career around competing at the highest level. That career was suddenly on the line when he tore his ACL in training in March 2022.

We spoke with Ryan and his surgeon, Dr. Sean McMillan of Virtua Mount Holly Hospital in Mount Holly, New Jersey, about how the injury happened, why he chose the BEAR Implant, what it took to get back in the ring to win two championship titles and how he’s doing four years later.

Q: How did you tear your ACL?

Ryan: I was training with another UFC fighter, just going through some basic movements. He went for an upper body takedown and wrapped his leg around mine. I fell backward, my foot stayed planted on the mat, and my knee went the wrong direction. I heard a loud pop. Then a crunch. I screamed.

Q: What were your initial thoughts after the diagnosis?

Ryan: I was devastated because I thought my career was over after reading so many horror stories about athletes never being the same after traditional ACL reconstruction (ACLR). Tearing my ACL was one of my lowest points in my career. I truly thought my fighting days were over, and I would never compete again, let alone at a high level. The more I researched, the less I liked the idea of taking a piece of my patellar tendon for an ACLR. I kept thinking there had to be another option. That search led me to the BEAR Implant and ultimately enrolling in the BEAR III clinical trial.

Q: Why did you choose the BEAR Implant?

Ryan: The reduced risk ofosteoarthritis was one of the deciding factors for me in choosing the BEAR Implant over ACLR. Back in 2022 when I tore my ACL, the preclinical research found a significantly lower rate of osteoarthritis for the BEAR Implant compared to ACLR.

As an active professional fighter, I wasn’t willing to sacrifice my quality of life after fighting because I am also a coach. I have a very long career ahead of me where I still have to be able to move with top professional athletes. More importantly, I am a father and I want to be able to play with my child and watch him grow without worrying about my knee in the future. It was exciting to see the FDA updated the BEAR Implant label to show that patients who receive the implant are 6 times less likely to suffer from post-traumatic osteoarthritis in comparison to ACLR. It reaffirms I made the right choice.

Q: How does the BEAR Implant differ from traditional ACL reconstruction?

Dr. McMillan: With traditional ACL reconstruction, we remove the torn ACL and replace it with a graft, either from the patient’s own tendon or donor tissue.

With the BEAR Implant, we are trying to restore the patient’s native ACL, the ligament they were born with. We’re not taking tissue from somewhere else in the body or introducing foreign graft material. It gives us the opportunity to help the ACL heal itself, which is a very different approach.

Q: Why was the BEAR Implant a good option for Ryan?

Dr. McMillan: Ryan came in having already done serious research. He believed in the science and understood what recovery would require. We had a long conversation about the pros and cons, especially given his profession. For him, it came down to three things: following the protocol, being patient with the healing process, and trusting that the outcome was possible.

Q: Tell us about rehab.

Ryan: I am wired to go all out, so pulling back was genuinely hard. Staying inside the guidelines and not pushing too fast during those critical early months required a kind of discipline I had to work at. It became mental training as much as physical.

I put myself in a mindset that it was do or die. I was going to give this rehab 110% – everything I have. And if it failed and I couldn’t return back to competition, I could at least be at peace knowing I chose the best procedure and gave it the best shot at being as successful a surgery as possible. During rehab, I was focused on building the strength back in my leg and found a way to do some things every single day to improve the stability and function in my knee. Following the post-op protocol, I was back to training, kicking, and all aspects of MMA within 9 months. Within 11 months, I was able to return to the cage and get back to competing.

Q: What stood out about his recovery?

Dr. McMillan: One of the things that’s notable about Ryan’s rehab is his body bounced back quickly. I remember him coming in six weeks post-operatively showing muscle activation in his quadricep firing at a much higher rate than the average ACL reconstruction. That allowed him to springboard his recovery and accelerate it to get him back into the ring much quicker.

To go through that level of rehab, come back to fight, and then win a championship, that takes something most people do not have. He has become a genuine example for other athletes facing the same crossroads. Ryan’s story is remarkable in the sense that he had a challenge in front of him to not just go back to a traditional desk job or a laboring job, but to go back to a job where his knee is his livelihood. Since treating Ryan, I have had the opportunity to treat several other high level athletes across various sports who have cited Ryan’s journey as one of their biggest reasons for seeking the BEAR ACL surgery.

Q: Can you tell us about returning to fighting?

Ryan: Since getting the BEAR Implant, I’ve been able to capture two professional titles. Everyone sees the end result of a successful fight, but not everyone sees the warmup the morning of the fight when I’m attempting to make my body feel normal after cutting and rehydrating a significant portion of my body weight the night before. I also have to focus on having confidence in my training camp, remembering the reps I put in with elite coaches and teammates, as well as remembering why I fight and what I fight for.

Before a fight, my mind starts to ask questions like “am I ready for this?” and “is my knee going to hold up? As a fighter with the BEAR Implant, I always have to remind myself of the work I put in to get my knee back to normal: countless hours of rehab with a physical therapy team, positive imagery and mental training, recovery like ice baths and extreme cold temperatures.

Every little thing I’ve done to return to fighting form has played a small part in making that walk to the cage to compete. At the end of the day – win, lose or draw, it’s all been worth it to get back in there and feel alive. Every time I step into the cage, I am thankful for the BEAR Implant and how it’s given me a second chance to do what I love every day. I’m proud to share that since getting the implant, I’ve won two championships, been able to defend my Cage Fury Fighting Championships (CFFC) Featherweight title and be named as 2025 Male Fighter of the Year. In May 2026, I won my first international fight at the RIZIN 53 in Japan. It was a huge comeback victory for me in the third round with a dragon sleeper submission.

Q: How does your knee feel today?

Ryan: Today, my knee feels stronger than ever with the BEAR Implant. To come back, defend my championship title and keep doing what I love means everything and is something I don’t take for granted.

Q: How has getting the BEAR Implant changed your life and what are your plans for the future?

Ryan: It’s been a blessing and a wild ride. One of the coolest parts has been inspiring other people who have torn their ACLs. People reach out to me all the time, especially those who’ve had the same procedure, and I always try to give back and help however I can.

I’m focused on continuing to compete, coach, and get ready for my next fight.

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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.

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