Internal Brace Surgery: What It Is, How It Works, and Its Applications

What is Internal Brace Surgery?

Internal brace surgery is an innovative orthopedic technique that augments the primary repair of damaged ligaments or tendons with a high-strength synthetic tape, providing immediate stability and protecting the healing tissue.

What is Internal Brace Surgery?

Internal brace surgery, often referred to as ligament augmentation or internal bracing, is a surgical procedure designed to enhance the repair of an injured ligament or tendon rather than replacing it entirely. Unlike traditional repair methods that rely solely on suturing the torn ends together, an internal brace adds a strong, synthetic suture tape alongside the repaired tissue. This tape acts as an internal "seatbelt," reinforcing the repair and providing immediate mechanical support. The primary goal is to protect the delicate primary repair during the critical early stages of healing, allowing the body's natural tissues to recover more robustly and potentially accelerating the rehabilitation process.

How Does Internal Brace Surgery Work?

The mechanism behind internal brace surgery involves the strategic placement of a high-strength, biocompatible suture tape (typically made of polyethylene or a similar material) across the repaired ligament or tendon. The procedure generally follows these steps:

• Primary Repair: The surgeon first performs a standard repair of the torn ligament or tendon, bringing the damaged ends together with sutures.
• Augmentation: Once the primary repair is complete, the internal brace tape is then secured to the bone on either side of the repaired tissue using small, specialized anchors. The tape is tensioned appropriately to provide stability without restricting necessary movement.
• Mechanical Support: This tape acts as an internal scaffold, offloading stress from the healing ligament or tendon. It provides immediate structural integrity, allowing the repaired tissue to heal in a more protected environment.
• Biological Integration: Over time, the body's tissues can grow into and around the internal brace material, further strengthening the repair. The tape itself is generally left in place permanently.

Common Applications of Internal Brace Surgery

Internal brace surgery has gained significant traction across various orthopedic specialties, particularly in joints prone to ligamentous injuries.

• Ankle: One of the most common applications is in the repair of lateral ankle ligament injuries, such as tears of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). It helps stabilize the ankle joint and reduce the risk of chronic instability.
• Shoulder: It is used to augment repairs of the acromioclavicular (AC) joint, particularly in cases of severe AC joint separations, and can also be used to reinforce certain rotator cuff repairs or labral repairs.
• Elbow: Perhaps most famously, it is used in the context of Ulnar Collateral Ligament (UCL) repair in throwing athletes (often alongside traditional "Tommy John" reconstruction, or as a standalone repair for certain tears).
• Knee: While less common as a primary repair for major ligaments like the ACL, it is being explored as an augmentation for MCL (Medial Collateral Ligament) repairs or as an adjunct in certain PCL (Posterior Cruciate Ligament) reconstructions.

Advantages of Internal Brace Surgery

The integration of an internal brace offers several compelling benefits compared to traditional standalone repairs:

• Enhanced Stability: Provides immediate, robust mechanical stability to the injured joint, protecting the primary repair.
• Accelerated Rehabilitation: The added stability often allows for earlier initiation of rehabilitation protocols, including controlled range of motion and weight-bearing, which can lead to a faster return to activity.
• Reduced Re-Injury Risk: By shielding the healing tissue from excessive stress, it may lower the incidence of re-rupture or chronic instability.
• Preservation of Native Anatomy: Unlike reconstructive surgeries that replace the damaged ligament with a graft, internal bracing aims to preserve and heal the patient's own tissue.
• Minimally Invasive Potential: Many internal brace procedures can be performed arthroscopically or through small incisions, leading to less soft tissue disruption and potentially quicker recovery.
• Improved Outcomes for Athletes: Particularly beneficial for high-demand individuals and athletes who require rapid and reliable recovery.

Potential Disadvantages and Considerations

While highly beneficial, internal brace surgery is not without its considerations:

• Surgical Risks: As with any surgical procedure, there are inherent risks such as infection, bleeding, nerve damage, anesthesia complications, and scar tissue formation.
• Implant-Related Issues: Though rare, the synthetic tape can potentially cause irritation, foreign body reaction, or, in very rare cases, failure or loosening.
• Cost: The specialized materials and techniques involved may increase the overall cost of the procedure.
• Not for All Injuries: It is most effective for acute, repairable tears and may not be suitable for chronic, severely retracted, or highly degenerated ligaments where reconstruction might be a more appropriate option.
• Long-Term Data: While promising, the long-term outcomes and durability of internal brace systems are still being continuously studied as the technology is relatively newer than traditional repairs or reconstructions.

Recovery and Rehabilitation

Recovery from internal brace surgery is typically characterized by a structured, progressive rehabilitation program, often accelerated compared to non-augmented repairs.

• Immediate Post-Op: The joint will likely be immobilized or protected in a brace or cast for a short period to allow initial healing.
• Early Phase: Focus on pain management, swelling reduction, and gentle, controlled range of motion exercises. The internal brace allows for earlier, careful movement.
• Intermediate Phase: Progressive strengthening exercises are introduced, targeting muscles around the affected joint to restore stability and function.
• Advanced Phase: Sport-specific or activity-specific drills are incorporated, emphasizing agility, balance, and power, preparing the individual for a safe return to full activity.

The exact timeline varies significantly based on the injured joint, the severity of the injury, and individual patient factors. Adherence to a physical therapy program is paramount for achieving optimal outcomes.

Who is a Candidate for Internal Brace Surgery?

Candidacy for internal brace surgery is determined on a case-by-case basis by an orthopedic surgeon. Generally, ideal candidates include:

• Acute Ligament or Tendon Tears: Especially those where the tissue quality is good and the torn ends can be primarily repaired.
• Athletes and Active Individuals: Those who require a robust repair and potentially faster return to sport.
• Individuals with Ligamentous Instability: When non-surgical treatments have failed, and surgical repair is indicated.
• Specific Joint Injuries: Such as lateral ankle instability, certain UCL tears in the elbow, or AC joint separations.

A thorough medical evaluation, including imaging studies (MRI, X-ray), and a discussion of individual goals and lifestyle, is crucial to determine if internal brace surgery is the most appropriate treatment option.

The Future of Internal Brace Technology

The field of internal brace surgery continues to evolve rapidly. Research is ongoing to explore new materials, optimize surgical techniques, and expand its application to a wider range of orthopedic injuries. As clinical experience and long-term data accumulate, internal bracing is poised to become an even more integral part of modern orthopedic care, offering patients a promising pathway to robust healing and accelerated recovery.