Miach Orthopaedics announced today that the U.S. Food and Drug Administration (FDA) has expanded the approved indications for its BEAR (Bridge-Enhanced ACL Restoration) Implant to include children and adolescents of any age, as well as patients with partial ACL tears. This significant regulatory milestone broadens access to a technology that enables natural healing of the anterior cruciate ligament.
The BEAR Implant previously received De Novo Approval in 2020 for treating skeletally mature patients at least 14 years of age with complete ACL tears. To date, more than 5,000 patients have been treated with the device through clinical trials and commercial use.
"The way ACL tears are treated is reaching an inflection point, and the BEAR Implant is a significant driving force," said Patrick McBrayer, president and CEO of Miach Orthopaedics. "This FDA clearance is a significant step forward in our mission to change the standard of care in ACL surgery."
A Paradigm Shift in ACL Treatment
The BEAR Implant represents the first disruptive technology in ACL tear treatment in more than three decades. Unlike traditional ACL reconstruction (ACLR), which replaces the torn ligament with a graft harvested from elsewhere in the patient's body or from a donor, the BEAR Implant facilitates healing of the patient's own ACL.
During the minimally invasive procedure, surgeons inject a small amount of the patient's blood into the collagen-based implant and position it between the torn ends of the ACL. This combination enables the body to heal the torn ligament while maintaining its original attachments to the femur and tibia. As healing progresses, the implant is naturally resorbed by the body.
Addressing a Critical Need in Pediatric Orthopedics
The expanded approval is particularly significant for thousands of young athletes who suffer ACL tears annually. Traditional ACL reconstruction presents unique challenges in children with open growth plates, which are areas of cartilage at the ends of the femur and tibia critical for bone development.
Dr. Sean Keyes, pediatric orthopedic surgeon at AdventHealth for Children, explained the significance: "Surgery to fix an ACL tear is different in children because we are concerned about causing damage to the growth plates, which can lead to issues such as limb length discrepancies and angular deformities. The BEAR Implant allows us to restore the ACL to its original, natural state while preserving the growth plates. We believe this will improve the long-term health of the knee."
New Option for Partial ACL Tears
The expanded indication also includes partial ACL tears, providing surgeons with an additional treatment option between conservative management and complete reconstruction. While many partial tears are initially treated with physical therapy, bracing, and activity modifications, surgery is often recommended for substantial tears or when knee instability persists.
"Our goal in treating patients with partial tears is to return them to a healthy, stable knee in the least invasive way possible," said Dr. Nirav Amin, orthopedic surgeon at Premier Orthopaedic & Trauma Specialists in Southern California. "Until now, our options were conservative care with a watch and wait approach or ACL reconstruction, which completely removes their remaining healthy ACL tissue. The clearance of the BEAR Implant for partial tears enables us to offer patients an ACL-preserving procedure to stabilize their knees."
Clinical Evidence Supporting Expanded Use
The FDA's decision to expand the BEAR Implant's indications was supported by data from the BEAR III clinical trial and the Bridge Registry, with participants recently completing their two-year follow-up visits. These studies provided Level 1 clinical evidence demonstrating the implant's safety and efficacy in facilitating natural ACL healing.
The BEAR Implant is indicated for adults, adolescents, and children with complete or partial ruptures of the ACL, as confirmed by MRI. Patients must have an ACL stump attached to the tibia to construct the repair, and children with open physes must have sufficient bone in the femoral and tibial epiphyses to avoid disruption of growth plates during the procedure.
Market Impact and Future Outlook
Based in Westborough, Massachusetts, Miach Orthopaedics has positioned the BEAR Implant as a transformative technology in sports medicine and orthopedic surgery. The expanded approval is expected to significantly increase the potential patient population who can benefit from this approach.
For the thousands of young athletes who suffer ACL injuries each year, the BEAR Implant offers a promising alternative that works with their growing bodies rather than against them. As adoption continues to increase, this technology may fundamentally change how surgeons approach ACL injuries across all age groups.
