Fiber Tape Internal Brace: Concept, Applications, and Benefits

What is Fiber Tape Internal Brace?

The Fiber Tape Internal Brace is an innovative orthopedic surgical technique that augments primary ligament or tendon repairs using a strong, biocompatible tape, providing immediate stability, promoting natural healing, and facilitating accelerated rehabilitation.

Understanding the Concept: What is an Internal Brace?

An internal brace, in the context of orthopedic surgery, refers to a surgical technique designed to augment or reinforce a primary repair of a ligament or tendon, rather than replacing it entirely. Unlike traditional braces worn externally, an internal brace is surgically implanted within the body. Its primary purpose is to provide immediate, robust mechanical support to the injured tissue, protecting the delicate primary repair during the critical early stages of healing. This support helps to offload stress from the healing tissues, allowing them to regenerate and regain strength more effectively.

The Role of Fiber Tape in Internal Bracing

The "Fiber Tape" in Fiber Tape Internal Brace specifically refers to a high-strength, ultra-high molecular weight polyethylene (UHMWPE) suture tape developed by Arthrex. This material is exceptionally strong, durable, and biocompatible, meaning it is well-tolerated by the body.

• Material Properties: FiberTape is known for its superior strength compared to traditional sutures, its low profile, and its ability to distribute load over a wider area.
• Augmentation, Not Replacement: It is crucial to understand that FiberTape is not a substitute for the damaged ligament or tendon. Instead, it acts as a scaffold or a "seatbelt" for the healing tissue, augmenting the native repair and providing a robust internal framework.

How Fiber Tape Internal Brace Works

The mechanism of action for the Fiber Tape Internal Brace is rooted in biomechanical principles:

• Load Sharing: By fixating the FiberTape across the repaired ligament or tendon, the internal brace shares the mechanical load that would otherwise be borne entirely by the healing tissue. This reduces stress on the primary repair, minimizing the risk of re-injury or stretching out during the early, vulnerable healing phase.
• Promoting Healing: The stability provided by the internal brace creates an optimal environment for biological healing. Reduced motion and stress allow the body's natural repair processes (collagen synthesis, cellular regeneration) to proceed more efficiently.
• Early Mobilization: The enhanced stability often allows for earlier and more aggressive rehabilitation protocols. Patients may be able to start range-of-motion exercises and weight-bearing activities sooner, which can prevent joint stiffness, muscle atrophy, and accelerate the overall recovery timeline.

Common Applications in Orthopedic Surgery

The Fiber Tape Internal Brace technique has gained significant traction across various orthopedic subspecialties due to its versatility and reported benefits:

• Ankle Ligament Repair: Most commonly used for acute lateral ankle ligament tears, particularly the anterior talofibular ligament (ATFL). It augments the direct repair of the torn ligament, providing immediate stability to the ankle joint.
• Ulnar Collateral Ligament (UCL) Repair (Tommy John Surgery Augmentation): In some cases of UCL tears in the elbow, particularly in athletes, the Fiber Tape Internal Brace can be used to augment a primary repair, potentially avoiding a full ligament reconstruction with a graft.
• Shoulder Instability: Used in conjunction with labral repairs (e.g., Bankart lesions) to reinforce the glenohumeral joint capsule and prevent recurrent dislocations.
• Achilles Tendon Repair: Can be used to augment a primary Achilles tendon repair, especially in cases of larger defects or in patients seeking an accelerated return to activity.
• Other Emerging Uses: Its application is continually being explored for other ligament and tendon injuries, including certain knee ligament repairs and foot and hand surgeries.

Advantages and Benefits

The Fiber Tape Internal Brace offers several compelling advantages for both surgeons and patients:

• Enhanced Stability and Strength: Provides immediate, robust mechanical support to the injured joint or tendon, superior to traditional suture-only repairs.
• Accelerated Rehabilitation: The increased stability often allows for earlier weight-bearing and range of motion, leading to a faster and potentially more complete return to daily activities and sport.
• Reduced Re-injury Rates: By protecting the healing tissue, it may decrease the likelihood of re-rupture or chronic instability.
• Preservation of Native Anatomy: Unlike reconstruction techniques that replace the damaged tissue with a graft, the internal brace augments the existing tissue, preserving the patient's natural anatomy and biomechanics.
• Minimally Invasive: The procedure can often be performed using arthroscopic or minimally invasive techniques, leading to smaller incisions, less pain, and quicker initial recovery.

Important Considerations and Limitations

While highly beneficial, the Fiber Tape Internal Brace is not without considerations:

• Surgical Procedure: It requires an invasive surgical procedure with associated risks (infection, nerve damage, anesthesia complications).
• Augmentation, Not Replacement: It is critical to remember that the internal brace augments, rather than replaces, the damaged tissue. The success still relies on the primary repair and the body's ability to heal.
• Cost: The specialized materials and techniques involved can make the procedure more costly than traditional repairs.
• Long-Term Data: While promising, the long-term outcomes and durability of Fiber Tape Internal Braces are still being studied as the technique is relatively new compared to established procedures.
• Potential for Stiffness or Irritation: In some cases, the presence of the tape within the joint could theoretically lead to irritation or stiffness, though this is uncommon.

Who is a Candidate for Fiber Tape Internal Brace?

Candidacy for a Fiber Tape Internal Brace procedure is determined by an orthopedic surgeon based on several factors, including:

• Type and Severity of Injury: Best suited for acute ligament or tendon tears where a primary repair is feasible.
• Patient Activity Level and Goals: Often considered for athletes or individuals with high functional demands who desire a quicker and more robust return to activity.
• Age and Overall Health: General health status and absence of contraindications for surgery.
• Surgeon's Expertise: The technique requires specialized training and experience.

The Future of Internal Bracing Technology

The Fiber Tape Internal Brace represents a significant advancement in orthopedic surgery, and the field continues to evolve. Future developments may include:

• Biodegradable Materials: Research into internal bracing materials that resorb over time as the native tissue heals, potentially reducing long-term foreign body presence.
• Integration with Biologics: Combining internal bracing with biologics (e.g., PRP, stem cells) to further enhance healing and tissue regeneration.
• Expanded Applications: Continued exploration and validation of the technique for a wider range of musculoskeletal injuries.

Conclusion

The Fiber Tape Internal Brace is a groundbreaking technique in orthopedic surgery, offering a powerful tool to augment primary ligament and tendon repairs. By providing immediate mechanical stability, it safeguards the healing tissue, potentially accelerating rehabilitation and improving long-term outcomes for a variety of injuries, particularly in the ankle, elbow, and shoulder. While not a standalone solution, it represents a significant step forward in optimizing the body's natural healing capacity and facilitating a more efficient return to function for patients.