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By Steve Andrews | Photos courtesy of Miach Orthopaedics

New ACL Surgical Technique Showing Early Benefits to Patients

A Bentonville orthopedic surgeon is the first Arkansas physician to use the Bridge Enhanced ACL Restoration implant

Dr. Chris Dougherty

Although tears to the knee’s anterior cruciate ligament seem to be most prevalent in amateur and professional athletes, it is actually one of the most frequently suffered knee injuries in America, reaching upward of 400,000 occurrences each year.


ACL tears mostly occur in sports that involve extensive turning, twisting, jumping or sudden changes in direction, such as basketball, football, soccer, tennis and gymnastics. But it is also a common injury for leisure sports enthusiasts as well as those performing other basic physical activities.


“It’s very common, as far as injuries go,” said Dr. Chris Dougherty, a Bentonville orthopedic surgeon. “You can have someone working out in their garden who slips and tears their ACL.”


At one time, such knee injuries usually meant the end of athletic careers or normal activities, but with the advancement of medical techniques throughout the past four decades, the recovery rate has grown dramatically. Advances in research and sports medicine have allowed many affected athletes, even those with severe tears, to return to their previous level of sports activities.

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Torn ACL

Surgeon adds patient's own blood

Surgeon inserts BEAR implant between torn ends of ACL

BEAR implant is replaced with healed ACL

The ACL is located on the front side of the knee, crossing with the posterior cruciate ligament to help stabilize the knee and prevent excessive forward movement of the femur (thigh bone) over the tibia (shin bone). An ACL tear is commonly identified by a loud “pop,” followed by pain and excessive swelling around the knee.


The latest breakthrough in ACL repair literally comes from the farm and has proven to reduce recovery time and promote natural regrowth of the ligament. The Bridge Enhanced ACL Restoration implant surgery is a revolutionary procedure in which an ACL is repaired by inserting a bovine collagen implant between the torn ends of the ligament. The collagen implant is then filled with the patient’s own blood to enhance the natural regrowth.


“This new repair technique is a game-changer because for the first time, you can actually restore your ACL and regrow it,” Dougherty said. “This surgery has a chance to recreate your natural knee, and unlike repairs with grafts, it lets you take your knee back to time zero before the injury.”


Until the development of the BEAR, the most common ACL reconstruction surgery has consisted of replacing the torn ligament with another ligament, usually retrieved from the hamstring tendons or patellar tendon — a process commonly known as the Bone-Patellar Tendon-Bone graft.

“The BPTB was considered the gold standard because that’s what they came up with first,” Dougherty said. “But I foresee this BEAR procedure becoming the new gold-standard because there is nothing better than using your own native tissue.”


The new technique was approved by the Food and Drug Administration in 2020, and Dougherty is the first physician in Arkansas to offer the procedure.


Dougherty, a sports medicine and orthopedic surgeon at Agility Center Orthopedics, has been the team physician for the Northwest Arkansas Naturals since 2008. He has pioneered innovative surgical procedures that have been adopted worldwide, as well as developed the most advanced rehab protocols in the state.


Over the past nine months, Dougherty has performed 15 of the BEAR implant surgeries and witnessed immediate advantages in the healing process. Within eight weeks, the implant is replaced with native cells, collagen and blood vessels as the new tissue continues to strengthen over time.

The one caveat is that the BEAR procedure is not suitable for all ACL injuries. The torn ligament must leave a remaining stump on the bottom portion of the knee in order to stitch on the collagen implant. Once attached, the collagen is able to grow a new ACL.


“If there is a stump, I can make it work, but if there is no stump, I can’t do it,” Dougherty said. “I have still had to do just as many of the other reconstructive surgeries because they were not candidates for the BEAR.”


Both methods of ACL surgeries are performed using a minimally invasive arthroscopic procedure in which a fiber-optic camera is inserted into the knee through a small surgical incision — about the width of an index finger. A small camera, connected to a video monitor, is then inserted, allowing the surgeon to examine and repair the knee.

The concept of the BEAR technique was developed by Dr. Martha Murray of Boston, who began using collagen from cows to treat ACL tears in pigs back 

in 2008. Not only did she discover that the collagen enabled the ligament to repair itself, but the procedure also led to significantly less arthritis in patients than standard graft reconstruction, another common problem associated with ACL injuries.


Many promising benefits have been shown from early clinical studies of the BEAR implant, including the decreased risk of osteoarthritis as well as the potential for more normal joint mechanics. And unlike reconstruction, the new procedure does not require a second surgical wound site to remove a healthy tendon — or donor tendon — from another part of the leg. Thus, future hamstring and patella weakness are avoided.


Research has also shown a lesser chance of tearing the ACL in the opposite knee, likely because the natural biomechanics are better preserved than that of reconstructive surgery.


“This is just an amazing advancement in surgical procedures,” Dougherty said. “This was a genius idea that Dr. Murray came up with. She adapted this new technology to her idea, and it works brilliantly.”


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