Patella, quadriceps, or hamstring?
If you’ve ever torn your ACL, you’ve probably had to face this question. For years, the standard treatment was ACL reconstruction, where surgeons replace the torn ligament with new tissue, often using a graft from your own hamstring, quadriceps, or patellar tendon. But now, a newer option—the BEAR procedure (Bridge-Enhanced ACL Restoration)—is giving patients another choice.
ACL Reconstruction (the standard surgery)
ACL reconstruction is a lot like replacing a broken rope with a brand-new one. Surgeons take a piece of tendon—usually from your hamstring or patellar tendon, or sometimes from a donor—and use it to create a “new” ACL. This surgery has an excellent track record, but it comes with some drawbacks. The original ACL is permanently removed, recovery often takes 9–12 months, the donor site (if tissue is taken from your body) can stay sore, and many patients feel their knee never returns to quite the same as before the injury.
The BEAR Procedure (the newer option)
The BEAR procedure takes a different approach: instead of replacing the ACL, it repairs it. During surgery, the torn ends of the ligament are stitched together, and a small sponge-like scaffold is placed between them and filled with the patient’s own blood. This scaffold helps the ligament heal naturally. The big advantage? Patients keep their own ACL, which may help the knee feel more “normal” after recovery, since the original tissue and nerve endings are preserved.
Who Is a Candidate for the BEAR Procedure?
A surgeon may recommend the BEAR procedure when the torn ACL is still in good condition and can be repaired rather than replaced. This usually means the tear is recent, the ligament ends are healthy enough to stitch back together, and the patient is younger or active and would benefit from preserving their own ACL. BEAR may also be chosen when maintaining the ligament’s natural nerve endings is a priority, since this can improve how the knee feels after recovery. However, if the ACL is too badly damaged, the injury is old, or there are other significant knee injuries, ACL reconstruction is usually the better option.
BEAR vs. ACL Reconstruction: Long-Term Outcomes
Similar results: At two years, BEAR patients do just as well as reconstruction patients in knee function and stability.
Stronger hamstrings: BEAR patients often keep more hamstring strength, since no tendon is removed for a graft.
Faster return-to-sport readiness: Some studies suggest BEAR patients feel ready to return a little sooner.
Slightly higher retear risk: BEAR may carry a slightly higher chance of retear, especially in younger patients, though differences aren’t always significant.
Possible long-term benefits: Early research hints that BEAR could lower the risk of arthritis later on, but more studies are needed.
The Bottom Line
Both BEAR and ACL reconstruction are effective surgeries. BEAR offers the exciting possibility of keeping your own ACL and preserving strength, but it isn’t right for everyone and is still a newer option with fewer long-term studies. ACL reconstruction remains the most proven surgery, with decades of successful outcomes.
If you’re facing an ACL injury, talk with your surgeon about whether BEAR could be right for you. Knowing your options can help you make the best decision for your recovery and long-term knee health.