When the BEAR^® Implant was first introduced, it represented a completely new way to treat anterior cruciate ligament (ACL) tears, using the body’s own biology to heal rather than replacing the ligament with a graft. Early studies showed the safety and effectiveness of the BEAR Implant, but they were conducted under tightly controlled conditions. Surgeries were conducted at one site and had to be performed within 50 days of injury, the technique was standardized, and only mid-substance tears were included.

With the two-year results from the Bridge Registry, we now have additional information on the safety and efficacy of the BEAR Implant in everyday clinical practice. This registry is a multi-center study that includes different surgical techniques, a broader range of patient ages, and surgery performed beyond the 50-day mark.

Key Findings at Two Years

The Bridge Registry is a prospective, multicenter cohort study that follows patients treated with the BEAR Implant at sites across the U.S. Unlike earlier trials, the registry collects data on how the procedure is being used in a real-world setting.

At the two-year mark, this broader approach provides new insight into how the BEAR Implant performs outside the boundaries of earlier trials. Following are three key findings, with perspectives from Jacqueline M. Brady, MD, co-principal investigator of the Bridge Registry and associate professor at Oregon Health and Science University.

1. Timing of Surgery is More Flexible 

The average time from injury to surgery was 46 days, with some procedures performed more than 150 days after injury. Importantly, outcomes were not negatively impacted even when surgery was delayed. This broadens the opportunity for patients who do not have immediate access to surgery or who need additional time to prehab.

“The results of the Bridge Registry show that outcomes were not negatively impacted even when surgery is performed later than the original 50-day cutoff,” Dr. Brady says. “It is important to note that the indication for the BEAR Implant was updated in recent years to focus on tissue quality rather than a strict time limit.”

2. Lower Retear Rates Compared to Early Trials 

The first 100 patients with two-year follow-up showed a 5% retear rate, compared to nearly 14% in the earlier BEAR II trial and 5-20% in the published literature for ACL reconstruction. Younger athletes under 18 had a slightly higher risk at 8%, usually related to reinjury during high-demand sports, while rates in adults were only 4%.

“We were pleasantly surprised to find that the retear rate was so low, and lower than both BEAR II and ACL reconstruction studies,” Dr. Brady says.

3. Evolving Surgical Techniques May Be Making a Difference 

Many surgeons in the registry have explored technique modifications, including use of high-strength sutures instead of absorbable, anchor fixation instead of buttons particularly on the tibia, and alternative suture patterns that allow for more flexibility during repair of ACL bundles. Study investigators hypothesize that these refinements may be one reason for the low retear rate. Just as important, surgeons have the flexibility to use the methods and materials they trust most.

“Technique modifications that have been studied to date are safe and seem to lower failure rates, so surgeons can use the fixation techniques and sutures they are most comfortable with,” Dr. Brady says.

For more information on Bridge Registry results, access these resources:

One-Year Results Publication

Two-Year Results Webinar

What This Means for Patients and Surgeons 

For patients, the takeaway is that the BEAR Implant continues to show strong, real-world results. Surgery does not need to be rushed into a narrow window, and failure rates remain low even as surgeons individualize their approach.

For surgeons, the registry provides reassurance that the BEAR Implant is adaptable. It works well across different fixation strategies, with a broad patient population, and outside the controlled conditions of earlier studies.

Looking Ahead 

Researchers will continue to follow the full registry of 300 patients, and longer-term questions remain, such as whether the BEAR Implant can reduce the risk of post-traumatic osteoarthritis as seen in animal studies.

“We’re starting to see hints of this effect in long-term studies,” Dr. Brady says. “If we find that to be true in human studies as well, that would be an incredible boost for ACL surgeries across the board.” 

Learn More about the BEAR Implant

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.

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-1370 Rev A 09/2025