Bridge Enhanced Anterior Cruciate Ligament Repair
Second-Place Article, 2016 Paper of the Year Competition

by Stephen A. Petruska, OTC

On Wednesday, March 21st 2016, orthopedic surgeon Doctor Martha Murray of Boston Children’s Hospital announced that she has successfully revolutionized the approach and procedure concerning the repair of a torn Anterior Cruciate ligament (ACL). The new procedure is called Bridge Enhanced ACL Repair or “BEAR” which has enabled a natural knitting and healing process of the ACL in order to bypass the past procedure of repair which involves an autograft/allograft relocation implant of a donor ligament in order to replace a damaged ACL. The anterior cruciate ligament is one of the ligaments of each knee, which attaches the front of the tibia to the back of the femur and functions to prevent hyperextension. Overall there are almost 1 half million anterior cruciate ligament injuries in the United States annually. With Doctor Murray’s new bridge enhanced ACL repair it is hoped that the healing process of this specific type of knee injury along with procedure related arthritis will be reduced. Only time will tell of the long-term durability concerning this style of repair.

The Bridge enhanced ACL repair program nicknamed the “BEAR program” at Boston Children’s Hospital began in 2015 with Phase 1, which had recruited 10 candidates for the experimental trials. The Phase 1 trials targeted patients within the 18 to 35 year old age range who have an ACL tear or rupture with remaining ACL tissue lengths meeting the specifications of the program. All ten of patients who have undergone Dr. Murray’s Bridge enhanced ACL repair at Boston Children’s Hospital have successfully begun to regrow healthy anterior cruciate ligaments. The first patient to successfully undergo the BEAR trials and fully regrow a healthy ACL was a 26-year-old doctoral student named Corey Peak. Mr. Peak ruptured his anterior cruciate ligament during a skiing accident during this past winter and agreed to the new experimental procedure. Peak spoke alongside Dr. Murray Wednesday during a news conference at Boston children’s hospital aimed to announce the success of the new program. Both Peak and Dr. Murray had extremely high hopes for the program as well as the long-term outcome of all of its patients.

The bridge enhanced anterior cruciate ligament repair procedure is performed by first having a patient with an ACL rupture or tear. The patient needs to have enough remaining ACL tissue in order for the procedure to work, there must be at last 8mm remaining on both superior and inferior portions which are to be sutured in a stable position for healing. The superior portion is sutured within the distal notch of the femur and inferior to the intercondylar eminence of the tibia. There is then a small sponge, which will act as the bridge that is then sutured in contact between both remaining portions of ACL. The sponge will then be filled by injection with blood drawn from that specific patient. The blood-saturated sponge forms a clot which intern creates a bridge of cells, which will jumpstart the healing process for new ACL growth. This new process in anterior cruciate ligament repair surgery will hopefully revolutionize the future of ligamentous repair surgeries. Again only time will be the judge in the overall success and longevity of the bridge enhanced anterior cruciate ligament repair procedure.

It is planned that during the summer of 2016 Dr. Murray will begin the Phase 2 of the BEAR trials at Boston Children’s hospital. Phase 2 will be accepting 100 patients for the study and will be targeting those in the 14 to 35 year old age range in order to begin testing the procedure on patients under the 18 year old age mark. The Phase 2 of the bear trials will be conducted over the course of 2 years. Bear Phase 2 will be conducted as a randomized double blind study over the course of its 2 year duration and sufficient data concerning the success of the study will not be known until summer of 2018. Phase 2 will evaluate how different patients ACL injuries will respond to certain medications and therapies throughout the healing process following the BEAR procedure. Dr. Murray is confident that with the knowledge gained from the Stage 1 trials that Boston Children’s Hospital will be successful during Stage 2. Dr. Murray along with members of her staff believe that they will in the future have the ability to move the study into different areas of the body for ligament repair such as the elbow for procedures such as Tommy John surgery.

I personally feel that the Bridge enhances ACL repair surgery is a revolutionary milestone in the field of health science for future procedures concerning ligamentous regrowth in the human body. I believe that Boston Children’s Hospital not only has the professional knowledge and tools to build upon the BEAR trials but can use knowledge gained in order to design a new program geared towards ligamentous regrowth of trauma patients such as car/motorcycle/boat accident victims, work related and gunshot related traumas, as well as other abnormal injuries to ligaments of the body caused by any number of externally related forces. I am also hopeful that the research and development of the BEAR trials can be passed into other areas of medical sciences such as orthopedics. If the same technology of regrowth can be applied to bones then a new approach could be taken in regard to fracture healing, orthopedic trauma and osteosarcoma treatments. I have learned as I spoke with William Maxwell lead orthopedic technologist at Boston Children’s Hospital. Mr. Maxwell said that “The Bear program is an incredible step in the right direction concerning healing and recovery for ACL injuries and that the research phases of studies such as Dr. Murray’s bridge enhanced ACL repair can definitely take some time to begin having it fully available to the public. This is just how the world of medicine works and the timeframes in which are required in order to have medicines and medical procedures tested and approved”. I personally work as an intern of Mr. Maxwell’s in the cast room at Boston Children’s Hospital and believe what he says concerning the forward movements and advancements of the facility and its studies.

In conclusion I am confident that I will see a great deal of advancement in the bridge enhanced ACL repair trials as I continue to be a part of Boston Children’s Hospital. This topic is definitely one in which I will be following its progression from its testing phases into its full availability to the public. I am extremely excited to be a part of Boston Children’s Hospital during the creation of this groundbreaking procedure and truly hope to encounter some of the BEAR patients in the hospital. Dr. Martha Murray has literally changed the face of anterior cruciate ligament repair and procedure.

About the Author:
Mr. Stephen A. Petruska graduated from New Hampshire Technical Institute in 2016 with an Associates of Health Science degree majoring in orthopaedic technology. Stephen chose to enter the field of orthopaedics after his own personal experiences of traumatic injury from a motor vehicle accident. Stephen completed his externship at Boston Children’s hospital, which was by far one of the greatest experiences of his life. Within the past 3 months Stephen has become a national board certified orthopaedic technologist and has relocated to the University of North Carolina Chapel Hill where he works as an OTC. Stephen enjoys, music, classic cars, motorcycles, fishing, mountain biking and animals. Stephen plans to continue his journey in the field of orthopaedic technology and wishes the very best to Professor Susan Turcotte and to all of his former NHTI Ortho Tech 2016 classmates.