Revolutionising ACL Repair: A Comparative Study of the STARR and BEAR Procedures for Athletes

Revolutionising ACL Repair: A Comparative Study of the STARR and BEAR Procedures for Athletes


Anterior Cruciate Ligament (ACL) injuries are a common but serious concern for athletes, often requiring surgical intervention. The development of new surgical techniques such as the STARR (Soft Tissue Augmented Regenerative Repair) and BEAR (Bridge-Enhanced ACL Repair) procedures offer promising alternatives to traditional ACL reconstruction. This article compares these two innovative methods, focusing on their applicability to athletic patients, the procedures themselves, and their respective benefits and drawbacks.

Understanding the STARR and BEAR Techniques

The STARR technique, pioneered by Professor Paul Lee, is a revolutionary approach that enhances the natural regenerative processes of the body. Unlike traditional methods that replace the torn ACL with a graft, STARR uses a biocompatible scaffold that integrates with the body’s own cells to regenerate the ligament and maintain its natural biomechanics.

In contrast, the BEAR procedure utilises a scaffold soaked in the patient’s blood to bridge the gap in the torn ACL, facilitating healing. This method relies on the natural healing response, similar to how other ligaments in the body recover without surgical intervention.

Benefits of the STARR Technique

  • Preservation of Natural Ligament: STARR maintains the original biomechanics of the ACL, potentially resulting in better long-term knee stability and function.
  • Minimally Invasive: Performed arthroscopically, STARR causes less surgical trauma and may lead to quicker recovery times.
  • Tailored Rehabilitation: Recovery protocols can be customised to the individual, promoting a more effective rehabilitation process.

Benefits of the BEAR Procedure

  • Natural Healing Promotion: By fostering a natural healing environment, the BEAR procedure can lead to a robust and durable ligament repair.
  • Reduced Complications: As a less invasive technique, BEAR carries a lower risk of complications like infections or graft failures when compared to traditional reconstruction.
  • Suitability for a Wide Range of Patients: This method can be advantageous for those with partial tears or where enough ligament is left to facilitate healing.

Drawbacks and Considerations

Both techniques have unique challenges:

  • STARR: The availability of materials and the need for specialised training can limit the widespread adoption of this technique.
  • BEAR: Early-stage research suggests potential for a higher inflammatory response due to the materials used, although recent modifications have aimed to mitigate these risks.

Who Should Choose Which Technique?

The choice between STARR and BEAR depends on individual circumstances, including the extent of the injury, the patient’s overall health, and their specific recovery goals. Athletes, who typically require a quick and effective return to high levels of activity, might prefer the STARR method due to its focus on preserving the knee’s natural mechanics and minimising recovery time. Conversely, the BEAR procedure may be more suited to those who are candidates for a more natural healing process and can afford a slightly longer recovery period.


  1. What is the recovery time for STARR vs. BEAR?

    • STARR: Typically shorter than traditional methods, with some patients returning to light activities within a few months.
    • BEAR: Similar to traditional ACL reconstruction, recovery can take from six months to a year.
  2. Are there activities I should avoid post-surgery?

    • High-impact sports should be avoided until cleared by a healthcare provider, irrespective of the surgical method.
  3. What are the long-term outcomes of these procedures?

    • Both procedures aim to provide long-lasting stability and function, but long-term outcomes can vary based on the success of the surgical procedure and adherence to rehabilitation.
  4. How do I know if I am a candidate for either procedure?

    • Consultation with an experienced orthopaedic surgeon is essential to determine the best approach based on your specific condition.
  5. Can these techniques be used for other ligaments?

    • Currently, they are primarily used for ACL injuries, but research is ongoing for other applications.
  6. What are the risks associated with STARR and BEAR?

    • As with any surgery, risks include infection, nerve damage, and incomplete healing. The specific risks can vary slightly between the two techniques.


Both the STARR and BEAR techniques represent significant advancements in the treatment of ACL injuries. For athletes looking to return to their sport, understanding the nuances of each method can guide a more informed decision, aligning their treatment choice with their sports performance and lifestyle goals. As research progresses, these techniques are set to redefine the standards of ACL repair, offering patients improved outcomes and faster recoveries.