BEAR Device vs. Autograft for ACL Tear

(BEAR-MOON Trial)

Recruiting in Palo Alto (17 mi)

+5 other locations

Overseen by Kurt Spindler, MD

Age: 18 - 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: The Cleveland Clinic

Must not be taking: Corticosteroids

Disqualifiers: Obesity, Smoking, Drug abuse, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial is testing BEAR, a new knee surgery method using a sponge to help a torn ligament heal. It targets patients aged 18-55 who need ACL surgery. The sponge helps the torn ligament ends grow back together naturally. BEAR has shown promising results in early studies, suggesting it may be a viable alternative to traditional ACL reconstruction methods.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you are using corticosteroids or have been treated with intra-articular corticosteroids in the affected knee within the last 6 months, you may not be eligible to participate.

What data supports the effectiveness of the treatment BEAR Device vs. Autograft for ACL Tear?

Research shows that using a bone-patellar tendon-bone (BPTB) autograft for ACL reconstruction is considered a reliable method with good long-term success rates. This technique is known for its strong graft fixation and early bone healing, which are important for effective ACL repair. ^{1 2 3 4 5}

Is the BEAR Device vs. Autograft for ACL Tear safe for humans?

The studies reviewed focus on the safety and effectiveness of bone-patellar tendon-bone (BPTB) autografts for ACL reconstruction, which is a common and generally safe procedure for repairing ACL tears. However, specific safety data for the BEAR device is not provided in these studies. ^{1 6 7 8 9}

What makes the BEAR Device treatment for ACL tears unique compared to other treatments?

The BEAR Device treatment for ACL tears is unique because it uses a special implant to encourage the body to heal the torn ligament naturally, rather than replacing it with a graft from another part of the body, which is common in traditional ACL reconstruction methods. ^{1 3 7 10 11}

Research Team

Kurt Spindler, MD

Principal Investigator

The Cleveland Clinic

Eligibility Criteria

This trial is for individuals aged 18-55 who have a complete ACL tear confirmed by MRI and are within 50 days of their injury. They must be considered candidates for ACL surgery, agree to follow study procedures including activity restrictions, and provide informed consent.

Inclusion Criteria

My surgery is within 50 days of my injury.

Complete ACL tear as confirmed by MRI

I have chosen surgery for my ACL injury.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgery and Initial Recovery

Participants undergo ACL surgery using either the BEAR device or BPTB reconstruction, followed by initial recovery

4-8 weeks

Rehabilitation

Participants follow specified rehabilitation protocols post-operatively

6 months

Follow-up

Participants are monitored for safety and effectiveness with assessments at 6 months, 1 year, and 2 years

2 years

Treatment Details

Interventions

• ACL Reconstruction (Bone Patellar Tendon Bone Graft) (Procedure)
• Bridge Enhanced ACL Repair (BEAR) (Device)
• Bridge Enhanced ACL Restoration (BEAR) (Device)

Trial Overview The study compares two surgical techniques for repairing torn ACLs: the new BEAR method using a blood-enriched implant to promote healing, versus the traditional BPTB reconstruction that uses transplanted patellar tendon tissue.

Participant Groups

Group I: Bridge Enhanced ACL Restoration Experimental Treatment 1 Intervention

Procedure/Surgery Bridge Enhanced ACL Restoration (BEAR): The surgical repair of the ACL using the BEAR technique involves surgically placing a sponge (the BEAR implant) between the torn ends of the ACL, providing a sponge for the ligament ends to group into.

Group II: ACL Reconstruction(BPTB Graft) Active Control 1 Intervention

Procedure/Surgery ACL Reconstruction (Bone Patellar Tendon Bone Graft): Standard of care surgical procedure Patellar Tendon Autograft ACL reconstruction, in which a bone-patellar tendon-bone graft from the front of the knee is taken to replace the torn ACL.

Who Is Running the Clinical Trial?

The Cleveland Clinic

Lead Sponsor

Trials

1,072

Recruited

1,377,000+

David Peter

The Cleveland Clinic

Chief Medical Officer

MD, board-certified in Hospice and Palliative Medicine

Tomislav Mihaljevic

The Cleveland Clinic

Chief Executive Officer since 2018

MD from University of Zagreb School of Medicine

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Collaborator

Trials

508

Recruited

1,090,000+

Dr. Lindsey A. Criswell

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Director since 2021

MD, MPH, DSc

Dr. Robert Colbert

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Clinical Director since 2014

MD

Miach Orthopaedics

Industry Sponsor

Trials

5

Recruited

1,300+

Findings from Research

The use of bone-patella tendon-bone (BPTB) autograft is highlighted as a gold standard technique for anterior cruciate ligament reconstruction (ACLR), emphasizing its established efficacy in surgical outcomes.

This Technical Note details a specific method of ACLR that employs press-fit femoral fixation with an outside-in drilling technique, which may enhance the stability and integration of the graft.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft With Press-Fit Femoral Fixation: The Original Chambat Technique. Levy, Y., Gousopoulos, L., Hopper, GP., et al.[2022]

In a study of 1009 matched patients followed for an average of over 8 years, those who had combined ACL reconstruction with anterolateral ligament reconstruction using hamstring tendon autografts had significantly lower rates of graft failure compared to those who had isolated ACL reconstruction with bone-patellar tendon-bone autografts.

Patients under 20 years old were particularly at risk, with a more than five-fold increase in graft ruptures compared to older patients, highlighting the importance of age in surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group. Pioger, C., Gousopoulos, L., Hopper, GP., et al.[2022]

A new surgical technique using bone-patellar tendon-bone (BTB) grafts for remnant-preserving, selective-bundle ACL augmentation was developed and tested in five young male patients, showing promising results without bone tunnel enlargement.

This method may provide a durable reconstruction option for patients with partial ACL tears, indicating its potential effectiveness in maintaining knee stability and function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Remnant-preserving, selective single-bundle augmentation of the anterior cruciate ligament using a bone-patellar tendon-bone autograft: A technical note. Tajima, T., Chosa, E., Yamaguchi, N., et al.[2022]

In the short term (up to 2 years), the bone-patellar tendon-bone (BPTB) autograft showed better knee stability compared to the four-strand hamstring tendon (4S-HT) autograft, as indicated by lower knee laxity and better pivot-shift test results in a meta-analysis of 23 randomized controlled trials involving 933 participants.

However, in the mid-term (3-5 years), the 4S-HT group demonstrated better objective knee function, while the BPTB group had more donor-site complications, such as anterior knee pain and extension deficits, suggesting that while BPTB may provide better short-term stability, it may lead to more long-term issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of the Central Third Patellar Tendon Versus Four-strand Hamstring Tendon Autograft Used for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Subgroup Meta-analysis of Randomized Controlled Trials. He, X., Yang, XG., Feng, JT., et al.[2022]

In a study of 121 patients undergoing ACL reconstruction, the addition of a lateral extra-articular tenodesis (LET) did not significantly improve long-term patient-reported outcomes compared to isolated ACL reconstruction with a bone-patellar tendon-bone graft.

However, the group that received LET showed a higher incidence of lateral compartment osteoarthritis (59% vs. 22%), suggesting that while LET may help with graft stability, it could also increase the risk of joint degeneration in the long term.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction With and Without Lateral Extra-articular Tenodesis: 19-Year Clinical and Radiological Follow-up. Castoldi, M., Magnussen, RA., Gunst, S., et al.[2020]

A systematic review of 4 randomized controlled trials involving 221 patients found no significant differences in clinical outcomes or knee pain between ACL reconstruction patients who had their patellar tendon defect closed versus those who did not.

The overall quality of the studies was low, which limits the reliability of the findings, as indicated by poor scores on the Modified Coleman Methodology Score and the Jadad scale.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Closure of patellar tendon defect in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: systematic review of randomized controlled trials. Frank, RM., Mascarenhas, R., Haro, M., et al.[2022]

A meta-analysis of 29 studies involving 3099 patients found no significant difference in the ability to return to preinjury levels of sports between patients who received bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts for ACL reconstruction, with a risk ratio of 1.03 (P = .63).

However, BPTB autografts showed a statistically significant advantage in knee stability, as indicated by a lower risk ratio of 0.66 for a positive pivot-shift test (P = .002), suggesting better knee stability outcomes with BPTB grafts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Return to Baseline Physical Activity After Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Bergeron, JJ., Sercia, QP., Drager, J., et al.[2022]

In a study of 107 patients aged 18 to 25, a majority (63.6%) preferred bone-patellar tendon-bone (BTB) grafts over hamstring grafts for ACL reconstruction, indicating a significant preference among young athletes for BTB due to its perceived benefits.

Patients who preferred BTB rated the importance of returning to sport and the risk of additional surgery due to graft failure higher than those who preferred hamstring grafts, while they were less concerned about knee pain and complication risks, highlighting the need to consider patient values in surgical decision-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient Decision Making in Anterior Cruciate Ligament Reconstruction: A Discrete Choice Experiment Examining Graft Preference. Sonnier, JH., Paul, RW., Sando, HE., et al.[2023]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Combined press-fit and extracortical fixation in patellar tendon anterior cruciate ligament reconstruction results in reliable graft fixation and early bone block incorporation. [2023]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft With Press-Fit Femoral Fixation: The Original Chambat Technique. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group. [2022]

4. India pubmed.ncbi.nlm.nih.gov

To study the incidence of heterotopic ossification after anterior cruciate ligament reconstruction. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Remnant-preserving, selective single-bundle augmentation of the anterior cruciate ligament using a bone-patellar tendon-bone autograft: A technical note. [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Clinical Outcomes of the Central Third Patellar Tendon Versus Four-strand Hamstring Tendon Autograft Used for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Subgroup Meta-analysis of Randomized Controlled Trials. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction With and Without Lateral Extra-articular Tenodesis: 19-Year Clinical and Radiological Follow-up. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Closure of patellar tendon defect in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: systematic review of randomized controlled trials. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Return to Baseline Physical Activity After Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Patient Decision Making in Anterior Cruciate Ligament Reconstruction: A Discrete Choice Experiment Examining Graft Preference. [2023]