The BEAR II Trial is a Level 1 RCT testing whether bridge-enhanced ACL repair — suturing the torn ACL with a resorbable bovine collagen scaffold soaked in autologous blood — is noninferior to hamstring autograft ACLR. The study enrolled 100 young, active patients (median age 17) with acute complete midsubstance ACL tears, randomized 2:1 to BEAR or ACLR, with 2-year follow-up.
Primary ACL repair without augmentation fails in roughly half of young, active patients — yet reconstruction requires harvesting normal tissue and leaves patients with measurable hamstring deficits that persist for at least 2 years.
This trial establishes BEAR as a biologically rational middle ground: repair the native ligament using a scaffold that restores what the joint environment destroys (the fibrin clot), without sacrificing the hamstring.
When evaluating a young athlete (ages 13-35) with a complete midsubstance ACL tear presenting within 45 days of injury and at least 50% tibial remnant preserved, BEAR is a legitimate alternative to autograft reconstruction with equivalent 2-year stability and patient-reported outcomes.
Counsel patients that roughly 1 in 7 will require conversion to ACLR within 2 years. But reassure them that conversion does not carry the outcome penalty seen after revision of a primary reconstruction. Longer-term data are pending, and this trial was conducted in a single center early in the BEAR learning curve, so results may improve with greater surgeon experience.
The BEAR II Trial is a Level 1 RCT testing whether bridge-enhanced ACL repair — suturing the torn ACL with a resorbable bovine collagen scaffold soaked in autologous blood — is noninferior to hamstring autograft ACLR. The study enrolled 100 young, active patients (median age 17) with acute complete midsubstance ACL tears, randomized 2:1 to BEAR or ACLR, with 2-year follow-up.
Primary ACL repair without augmentation fails in roughly half of young, active patients — yet reconstruction requires harvesting normal tissue and leaves patients with measurable hamstring deficits that persist for at least 2 years.
This trial establishes BEAR as a biologically rational middle ground: repair the native ligament using a scaffold that restores what the joint environment destroys (the fibrin clot), without sacrificing the hamstring.
When evaluating a young athlete (ages 13-35) with a complete midsubstance ACL tear presenting within 45 days of injury and at least 50% tibial remnant preserved, BEAR is a legitimate alternative to autograft reconstruction with equivalent 2-year stability and patient-reported outcomes.
Counsel patients that roughly 1 in 7 will require conversion to ACLR within 2 years. But reassure them that conversion does not carry the outcome penalty seen after revision of a primary reconstruction. Longer-term data are pending, and this trial was conducted in a single center early in the BEAR learning curve, so results may improve with greater surgeon experience.