Internal bracing is a significant advancement in orthopedic surgery for managing ligament and tendon injuries. This innovation uses a synthetic material to support a damaged structure, augmenting and protecting the biological repair during healing. The technique provides immediate stability to the injured tissue, facilitating a quicker return to function while mitigating the risk of re-injury from early mobilization.
The Underlying Mechanism of Internal Bracing
The core function of an internal brace is to act as a temporary, high-strength scaffold for the native ligament or tendon repair. This “seatbelt” mechanism is achieved through the implantation of a biocompatible polymer material, often a suture tape composed of ultra-high-molecular-weight polyethylene, such as FiberTape. The tape is fixed to the bone using anchors, spanning the length of the repaired ligament to provide immediate mechanical strength. This provides a load-sharing environment where the synthetic brace absorbs forces that would otherwise stress the healing biological tissue.
The internal brace protects the native repair from excessive strain, which often causes failure or laxity during early rehabilitation. This immediate structural support allows for early mobilization and an accelerated rehabilitation protocol. As the patient moves the joint, the ligament or tendon tissue strengthens naturally, with the synthetic tape preventing over-stretching or re-rupture.
How Internal Bracing Differs from Traditional Reconstruction
Internal bracing fundamentally differs from traditional ligament reconstruction in its underlying philosophy of tissue management. Traditional reconstruction involves replacing the damaged ligament entirely with a graft harvested from the patient (autograft) or a donor (allograft). This process requires the surgeon to drill bone tunnels and secure the replacement graft, which then needs time for the body to incorporate and revascularize before it achieves full strength. The internal brace, conversely, prioritizes preserving and augmenting the native ligament, only providing support for the existing structure.
A major procedural difference is the avoidance of graft harvesting, which eliminates donor site morbidity (pain or weakness where the graft was taken). Because the internal brace reinforces the existing ligament, it allows for a significantly earlier and more aggressive rehabilitation schedule compared to the six-to-nine-month wait associated with graft incorporation in traditional reconstruction. The retention of the original ligament tissue also helps to preserve the joint’s proprioception, the body’s sense of joint position, which is often diminished when the native ligament is replaced. The internal brace can also augment an existing graft in reconstruction cases, providing extra protection during the healing phase.
Primary Applications in Joint Stabilization
Internal bracing has been successfully applied across various joints to enhance stability and accelerate recovery. In the knee, it is used for anterior cruciate ligament (ACL) repair, where the ligament is stitched back together and the brace provides support, rather than replacing the ACL with a graft. This method promotes the healing of the native ACL during the early stages of recovery. Internal bracing is also increasingly used to stabilize the medial collateral ligament (MCL) and other structures within the knee joint.
The technique was initially developed for addressing chronic ankle instability, specifically augmenting the Brostrom repair of the lateral ligaments. In this application, the brace provides three times the strength of the standard repair alone, allowing for immediate range of motion and a faster return to activity. In the shoulder, the internal brace is utilized for acromioclavicular (AC) joint stabilization, where it is used in conjunction with other fixation methods to provide front-to-back and rotational stability.