The treatment of damaged ligaments and tendons has seen advancements in orthopedic surgery. One innovation is the internal brace system, a technique designed to stabilize and reinforce injured soft tissues. This surgical approach utilizes high-strength materials to provide immediate, robust support to the body’s natural structures. The internal brace protects the injured ligament while it undergoes its natural healing process. This method of augmentation represents a shift in surgical philosophy toward tissue preservation, aiming to enhance the strength of the repair and accelerate the patient’s rehabilitation timeline.
Defining the Internal Brace System
The internal brace system is a surgical construct composed of specific, high-performance materials implanted directly into the joint. The “brace” itself is typically a high-strength suture tape, often made from ultra-high-molecular-weight polyethylene. This material is exceptionally strong and designed to withstand the immediate mechanical stresses placed on the healing ligament or tendon.
The suture tape is secured to the bone on either side of the damaged ligament using small, specialized anchors or screws. These fixation devices, such as knotless SwiveLock anchors, create a secure, fixed point for the tape. The surgical goal is to provide a protective scaffold that shields the primary ligament repair from excessive strain during the early healing phase.
The system is used for augmentation, meaning it works alongside the repair of the native damaged tissue rather than replacing it entirely. This supplementary support allows for controlled, early joint movement. The suture tape serves as a temporary load-sharing device until the patient’s own tissue has healed sufficiently, facilitating an improved biological environment for regeneration.
Specific Orthopedic Applications
The internal brace technique has been successfully applied across various joints for the repair of acutely torn ligaments. One of the most common applications is in the ankle, specifically to augment the Brostrom procedure for chronic lateral ankle instability. The suture tape reinforces the primary repair of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), restoring immediate mechanical stability.
In the knee, the system supports the repair of various ligaments, including the medial collateral ligament (MCL) and, in select cases, the anterior cruciate ligament (ACL). When an ACL tear is near the bone and the tissue quality is good, a primary repair augmented with the internal brace may be attempted.
The technique is also used in the upper extremities, such as for stabilizing the ulnar collateral ligament (UCL) in the elbow, a common injury in overhead athletes. Furthermore, surgeons employ the internal brace for instability procedures in the shoulder, including augmentation of the acromioclavicular (AC) joint reconstruction. The versatility of the high-strength suture tape allows the technique to be tailored to the specific anatomical requirements of different joints.
Internal Brace vs. Traditional Repair
The primary distinction between the internal brace approach and traditional ligament surgery lies in the surgical philosophy. Traditional methods, particularly for complete ACL tears, involve ligament reconstruction, which requires removing the damaged native ligament entirely. This is then replaced with a graft, typically an autograft harvested from the patient’s own hamstring or patellar tendon, or an allograft from a donor. Reconstruction is a process of substitution, replacing the injured structure with new tissue.
In contrast, the internal brace is a technique of ligament repair and augmentation. The surgeon works to preserve the maximum amount of the patient’s native ligament tissue, stitching it back together. The high-strength suture tape is then installed alongside the repaired ligament to protect and reinforce it. This preservation is a significant advantage because it maintains the ligament’s original attachments to the bone.
Preserving the native tissue is theorized to help maintain proprioception, which is the body’s sense of joint position and movement. Ligaments contain specialized nerve endings that contribute to this sensory feedback, which is partially or fully lost when the ligament is completely removed and replaced. By retaining the original ligament, the internal brace technique aims to preserve this proprioceptive function, potentially leading to better long-term joint function and stability.
Another benefit of augmentation is the avoidance of donor site morbidity associated with autograft harvesting (pain, weakness, or scarring). The internal brace also avoids the potential for disease transmission and slower biological integration associated with allografts. Biomechanical studies have demonstrated that repairs augmented with the internal brace exhibit higher load-to-failure strength and stiffness compared to repairs without augmentation in the early post-operative period.
Post-Surgical Recovery and Outcomes
Patients undergoing a procedure with internal brace augmentation often follow an accelerated post-operative rehabilitation protocol compared to traditional reconstruction. The immediate mechanical support provided by the suture tape allows for earlier mobilization and range-of-motion exercises. This early movement helps reduce joint stiffness and minimize muscle atrophy that can occur with prolonged immobilization.
For ankle ligament repair augmented with an internal brace, patients may transition from a splint to a walking boot within a few days of surgery. They are often permitted to begin early weight-bearing and active range-of-motion exercises shortly after. This accelerated timeline can result in a return to unrestricted activities and sports significantly faster than with conventional repair techniques.
In some cases, the time to return to sport has been reported to be reduced by as much as 50% compared to traditional graft reconstruction. While the recovery is faster, it still requires adherence to a structured physical therapy plan to ensure a successful outcome. Potential long-term considerations include the risk of hardware irritation from the anchors or suture tape, though the failure rate of the internal brace itself appears to be low.