Internal Brace: Durability, Potential Failures, and Long-Term Care

Can an internal brace break?

While an internal brace is designed for exceptional strength and durability to support healing tissues, it is theoretically possible, though rare, for it to fail or break under extreme conditions or due to other complicating factors.

Understanding the Internal Brace

The term "internal brace" refers to a surgical augmentation technique, typically involving the use of high-strength, non-absorbable suture tape (often made from materials like polyethylene) to reinforce a primary ligament or tendon repair. It's not a standalone replacement for a structure but rather a protective scaffold.

• What is an Internal Brace? An internal brace, more accurately known as suture tape augmentation, is a surgical procedure where a robust synthetic tape is placed alongside a repaired ligament or tendon. It acts as an internal splint, providing immediate mechanical stability to the healing tissue.
• Purpose and Function: Its primary purpose is to offload stress from the primary repair, protecting it during the critical early healing phases. This protection allows for potentially faster, more aggressive rehabilitation and can reduce the risk of re-injury or repair failure. It complements, rather than replaces, the body's natural healing process.
• Common Applications: Internal brace techniques have seen increasing adoption across various orthopedic procedures, including:
  • Anterior Cruciate Ligament (ACL) reconstruction
  • Medial Collateral Ligament (MCL) repair in the knee
  • Achilles tendon repair
  • Acromioclavicular (AC) joint reconstruction in the shoulder
  • Lateral ankle ligament repair

The Durability of Internal Braces

Internal braces are engineered to withstand significant biomechanical forces, a critical requirement given their role in supporting musculoskeletal structures.

• Material Composition: The tapes used are typically composed of ultra-high molecular weight polyethylene (UHMWPE), a material known for its exceptional strength-to-weight ratio, high tensile strength, and resistance to fatigue and abrasion. These materials are biocompatible and designed for long-term implantation within the body.
• Biomechanical Design: The tapes are designed to mimic the natural forces experienced by ligaments and tendons, distributing load effectively. They are anchored securely into bone using specialized screws or buttons, creating a robust construct.
• Rigorous Testing: Before clinical use, internal brace systems undergo extensive biomechanical testing in laboratories to assess their tensile strength, fatigue resistance, and overall durability under simulated physiological loads. This testing aims to ensure the device can withstand the stresses of everyday movement and rehabilitation.

Can an Internal Brace Fail or Break?

While highly durable, it's important to understand the nuances of internal brace failure.

• Direct Answer: Yes, but Rarely. The actual material of the internal brace breaking (i.e., the suture tape snapping) is exceedingly rare. The design and material science minimize this risk. However, "failure" can encompass other scenarios beyond a literal break in the tape.
• Mechanisms of Failure (Beyond a Literal Break):
  • Anchor Pull-Out: More common than the tape breaking is the anchors (screws or buttons) pulling out of the bone, particularly in cases of poor bone quality or excessive, premature loading.
  • Tape Elongation/Loosening: While designed for minimal stretch, over time or under repeated high loads, the tape could slightly elongate or the construct could loosen, leading to reduced stability.
  • Perforation or Fraying: Though rare, sharp bone edges or repetitive friction could theoretically cause localized damage to the tape.
  • Surgical Technique Issues: Improper tensioning of the tape, suboptimal anchor placement, or inadequate bone preparation during surgery can compromise the integrity of the entire construct.
  • Biological Integration Failure: While the internal brace is synthetic, its success relies on the primary tissue repair healing effectively around it. If the biological healing of the primary ligament or tendon fails, the internal brace alone may not be sufficient to maintain stability, even if it remains intact.
  • Acute Traumatic Overload: A severe, high-energy traumatic event that far exceeds the design limits of the brace and the healing tissue could potentially lead to failure of the construct, including anchor pull-out or, in extreme cases, tape rupture.

Factors Influencing Internal Brace Integrity

Several factors contribute to the long-term success and integrity of an internal brace.

• Patient-Specific Factors:
  • Bone Quality: Good bone density is crucial for secure anchor fixation.
  • Tissue Healing Capacity: The patient's ability to heal the primary repaired tissue is paramount.
  • Activity Level and Compliance: Adherence to post-operative restrictions and gradual return to activity is critical. Premature or excessive loading can jeopardize the repair.
• Surgical Factors:
  • Correct Tensioning: Applying the appropriate tension to the tape is vital for stability without over-constraining the joint.
  • Precise Anchor Placement: Anchors must be placed in strong bone and at optimal angles.
  • Quality of Primary Repair: The internal brace augments, but does not replace, a sound primary surgical repair.
• Post-Operative Rehabilitation:
  • Adherence to Protocols: Following the prescribed physical therapy regimen, including weight-bearing and range-of-motion restrictions, is fundamental.
  • Controlled Loading: Gradual, progressive loading of the healing tissue under the guidance of a physical therapist is essential for strengthening and adaptation.

Recognizing Potential Issues

While rare, it's important for individuals with an internal brace to be aware of signs that might indicate a problem.

• Signs and Symptoms: If the internal brace construct were to fail, symptoms might include:
  • Increased pain at the surgical site or within the joint.
  • Recurrent instability or a feeling of "giving way" in the joint.
  • New or increased swelling that doesn't resolve.
  • Loss of range of motion or difficulty with movements that were previously improving.
  • A "pop" or tearing sensation followed by acute pain and instability (in the case of acute traumatic failure).
• When to Seek Medical Attention: Any of these symptoms, especially if they occur suddenly or worsen over time, warrant immediate evaluation by your orthopedic surgeon or physical therapist. Prompt assessment can help determine the cause and guide appropriate management.

The Role of Rehabilitation and Long-Term Care

Successful outcomes with an internal brace heavily rely on meticulous rehabilitation and prudent long-term management.

• Gradual Progression: Rehabilitation protocols are designed to progressively increase load on the healing tissues while ensuring the internal brace is protected. This balance is key to promoting strong tissue healing and preventing overload.
• Strengthening and Proprioception: Focused exercises to strengthen the muscles surrounding the joint and improve proprioception (the body's sense of position and movement) are crucial. A strong, well-coordinated musculature provides dynamic stability, further protecting the internal brace and repaired tissue.
• Activity Modification: Understanding the limits of the repaired joint and avoiding activities that place undue stress on it, especially during the early healing phases, is vital.
• Regular Follow-ups: Adhering to scheduled follow-up appointments with your surgeon and physical therapist allows for continuous monitoring of your progress and the integrity of the repair.

Conclusion

An internal brace represents a significant advancement in orthopedic surgery, offering enhanced stability and protection to healing ligaments and tendons. While the materials are incredibly strong, the integrity of the entire surgical construct — including the internal brace, its anchors, the primary tissue repair, and surrounding bone — can be influenced by surgical precision, patient factors, and rehabilitation adherence. A literal break in the internal brace material is exceptionally rare. Far more common are issues like anchor pull-out or failure of the primary biological repair. Optimal outcomes are achieved through careful surgical technique, diligent adherence to rehabilitation protocols, and a gradual, informed return to activity, all under the guidance of your healthcare team.