Internal Brace: How it Works, Applications, and Benefits in Orthopedic Surgery

How does internal brace work?

The internal brace is an innovative surgical augmentation technique designed to provide immediate biomechanical support to injured ligaments or tendons, facilitating earlier rehabilitation and promoting natural tissue healing by sharing load and acting as a scaffold.

Understanding Ligament and Tendon Injuries

Ligaments and tendons are crucial connective tissues that stabilize joints and transmit forces from muscles to bones, respectively. When these structures are acutely injured (e.g., a tear or rupture), the body's natural healing process can be slow, incomplete, or require prolonged immobilization to protect the repair. Traditional surgical approaches often involve reconstruction (replacing the torn tissue with a graft) or extensive protection of a primary repair, leading to extended recovery times and potential muscle atrophy. The internal brace technique emerged as a solution to enhance the stability of repairs and accelerate the rehabilitation process.

What is the Internal Brace?

The internal brace is not a standalone repair or reconstruction; rather, it is a surgical augmentation system used in conjunction with a primary repair of a ligament or tendon. It typically involves the use of a high-strength, non-absorbable suture tape (commonly FiberTape® by Arthrex) secured to bone using small anchors.

The key distinction is that the internal brace reinforces or augments the injured tissue or its primary repair, providing immediate stability. It works by acting as an additional support structure, allowing the body's natural healing mechanisms to take place under protected conditions, rather than entirely replacing the damaged tissue.

The Biomechanics of the Internal Brace: Aiding Healing and Stability

The effectiveness of the internal brace lies in its biomechanical principles:

• Immediate Load Sharing: The high-strength suture tape is strategically placed to offload some of the tensile forces that would otherwise be borne entirely by the healing ligament or tendon. By sharing the load, the internal brace protects the delicate primary repair from excessive stress during the critical early stages of healing, reducing the risk of re-rupture or stretching out of the repair.
• Scaffolding for Biological Healing: The suture tape acts as an internal scaffold, providing a stable framework along which new collagen fibers can grow and align. This organized growth of new tissue is crucial for the long-term strength and integrity of the repaired structure. The presence of the brace encourages a more robust and organized healing response.
• Enhanced Stability and Proprioception: By providing immediate structural integrity, the internal brace helps restore joint stability. This improved stability can also positively impact proprioception—the body's sense of joint position and movement—which is vital for functional recovery and preventing re-injury.
• Facilitating Early Rehabilitation: Perhaps the most significant advantage is the ability to initiate accelerated rehabilitation protocols. Because the internal brace provides immediate protection and stability, patients can often begin controlled range-of-motion exercises and early weight-bearing much sooner than with traditional methods. This early mobilization helps prevent joint stiffness, muscle atrophy, and promotes blood flow, which is beneficial for healing.

Common Applications in Orthopedic Surgery

The internal brace technique has found widespread application in various orthopedic procedures, particularly for acute ligament and tendon injuries where primary repair is feasible:

• Anterior Cruciate Ligament (ACL) Repair: For specific types of ACL tears (e.g., proximal avulsion tears) where the native ligament can be repaired rather than reconstructed, the internal brace provides critical augmentation, protecting the repair and allowing for earlier mobilization.
• Medial Collateral Ligament (MCL) Repair: Used to reinforce primary repairs of the MCL in the knee, especially in multi-ligamentous injuries.
• Achilles Tendon Repair: Augmenting the direct suture repair of a ruptured Achilles tendon, reducing the risk of re-rupture and enabling earlier weight-bearing.
• Lateral Ankle Ligament Repair (ATFL/CFL): For acute tears of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), the internal brace enhances the stability of the primary repair, leading to faster recovery and reduced recurrence rates of instability.
• Ulnar Collateral Ligament (UCL) Repair (Tommy John Surgery): In cases of acute UCL tears in the elbow, the internal brace can be used to augment the native ligament repair, particularly important for overhead athletes.

Advantages of the Internal Brace System

• Accelerated Rehabilitation: Allows for faster progression through physical therapy, leading to quicker recovery.
• Preservation of Native Tissue: When applied to primary repairs, it helps retain the patient's original anatomy and biological properties, which can lead to more natural joint mechanics.
• Reduced Graft Morbidity: In cases where it avoids the need for a graft (autograft or allograft), it eliminates the associated pain, weakness, or complications from graft harvesting.
• Improved Biomechanical Stability: Provides robust, immediate support to the healing structure.
• Potentially Faster Return to Activity: Athletes and active individuals may return to their sport or occupation sooner.

Limitations and Considerations

While highly effective, the internal brace is not suitable for all injuries. It typically requires viable native tissue that can be primarily repaired. It may not be appropriate for chronic, highly degenerative tears or cases with significant tissue loss. Patient selection, surgical technique, and adherence to post-operative rehabilitation protocols are crucial for optimal outcomes. As with any surgical procedure, there are potential risks, though generally low.

The Role of Rehabilitation

Even with the enhanced stability provided by the internal brace, a structured and progressive rehabilitation program remains paramount. Physical therapy focuses on restoring range of motion, strength, proprioception, and functional movement patterns. The brace allows for earlier initiation of these exercises, but the principles of gradual loading and controlled progression are still strictly followed to ensure long-term success and prevent re-injury.

Conclusion

The internal brace represents a significant advancement in orthopedic surgery, offering a biomechanically sound approach to augment primary ligament and tendon repairs. By providing immediate load sharing and a biological scaffold, it protects healing tissues, allows for accelerated rehabilitation, and holds the promise of faster, more robust recovery for carefully selected patients. Its integration into modern surgical practice continues to expand, reflecting its efficacy in enhancing patient outcomes.