ACL Repair — Bridge-Enhanced ACL Restoration (BEAR Implant)

OrthoVirginia · Miach Orthopaedics (BEAR Implant manufacturer protocol, ML-1014 Rev F)

Weight-Bearing

PWB (up to 50% body weight) with crutches x 4-6 wks, brace locked at 0 deg for ambulation x 4 wks; advance to WBAT with crutch wean at 4-6 wks only with normal gait, no pain, no extensor lag and good quad control; crutch D/C with normal gait and reciprocal stairs

Key Restrictions

Brace locked 0 deg first 24 hrs, then ROM limits 0-30 deg wks 0-2, 0-60 deg wks 2-4, 0-90 deg wks 4-6; brace locked at 0 deg for sleep x 6 wks; no flexion past 90 deg until after wk 6; functional ACL brace once AROM flexion 110 deg or more; no manual PROM at any point; no CPM; no scar massage until 6 wks; E-stim is the only muscle stimulation modality; no driving until off narcotics (right leg: 2 wks and 60 deg flexion); no cutting or pivoting until Phase 6 (wk 30+); contact surgeon if stiffness observed

Timeline & Phases

Phase 0 (pre-op): teach home exercises, brace and crutch use; Phase 1 (0-4 wks): home program with PT supervision, extension/flexion exercises, quad sets, heel/toe raises, patellar mobs, cryotherapy; Phase 2 (4-7 wks): full extension, quad activation, SLR without lag, reciprocal stair training; Phase 3 (7-12 wks): normal gait, crutch D/C, wall slides/mini squats, hamstring and hip strengthening, aqua jogging from wk 8; Phase 4 (12-20 wks): full ROM, leg press, step-ups, balance, straight-line running around wk 18 with surgeon clearance; Phase 5 (20-30 wks): running, double-leg jumping to hopping, single-leg squats; Phase 6 (30-36 wks): agility and running patterns at 50-75% speed, plyometrics, hop tests at 75% then 85%; Phase 7 (36-52 wks): return to sport with 95% hop test symmetry, single-leg balance 30 sec, single-leg squat to 60 deg without valgus, IKDC Q10 > 9 and surgeon clearance

Notes

BEAR Implant restores the native ACL rather than replacing it, so this protocol is slower and more protective than standard ACLR protocols; the PDF numbers its later phases inconsistently (two labeled Phase 7, one Phase 8), renumbered here in order as Phases 5-7; criteria-based progression with minimum time gates at 4, 7, 12, 20 and 30 wks; stiffness noted as most likely in wks 4-7 with fear avoidance or adjunct meniscal repair, managed with prone hangs, patellar mobs and edema control; return-to-sport testing includes dynamometry, KT-1000 laxity and single/triple/crossover/timed hop tests in brace; appendix has patient after-surgery instructions, PWB scale technique and illustrated home exercises; secondary procedures (meniscal repair, other ligament surgery) may alter the protocol per surgeon

Surgeon / Author

Miach Orthopaedics (BEAR Implant manufacturer protocol, ML-1014 Rev F)

Published

September 2022