Dr. Daryl Osbahr on advancing ACL restoration surgery with Rothman, AdventHealth

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Orlando, Fla.-based AdventHealth in partnership with Rothman Orthopaedic Institute, headquartered in Philadelphia, became the first facility to complete 100 surgeries with the bridge-enhanced ACL restoration implant.

Daryl Osbahr, MD, a Rothman surgeon and executive medical director for the AdventHealth Orthopedic Institute, completed the majority of those BEAR cases, and he spoke with Becker's about his journey with the procedure.

Note: This conversation was lightly edited for clarity.

Question: Can you talk about your progress with ACL repair and the progression to utilization of the ACL BEAR implant?

Dr. Daryl Osbahr: ACL repair has reemerged as another great option for patients that have suffered an ACL injury. Rothman Orthopaedics at AdventHealth is dedicated to being on the cutting edge in the development of new surgical solutions to better optimize short- and long-term outcomes for our patients. The ACL Bridge Enhanced ACL Restoration implant and technique have been developed for this reason.

My journey with ACL repair really started about 10 years ago, when I began my search to find innovative ways to be able to repair the ACL tissue back to bone, including the utilization of internal ligament brace technology, and I had great success with these techniques. The BEAR implant and technique have further enhanced success in optimizing healing and outcomes for the benefit of the patients we serve in our community. So it's really expanded my indications for how I can treat patients with less invasive surgery and provide even more optimal results.

When it comes down to indications with the BEAR implant and technique, my goal is to individualize ACL treatment for each patient with the goal of matching the treatment plan to the patient's ultimate goals while taking into account risks and benefits. After I have a thorough discussion with the patient and go through all the options, I'm able to learn what a patient really values as an optimal recovery and outcome. I have realized that patients feel more informed and empowered when making the best decision as to what type of procedure, recovery, and outcome are most important to them.

Q: What is that differentiation between offering an ACL BEAR procedure versus ACL reconstruction?

DO: In terms of the ACL surgery plan, I talk about all options, listen to the patient, and help them decide about what the best option is for them. There are a multitude of questions to consider: Are they an elite-level athlete? What is their biggest fear? Are they concerned about pain and long-term arthritis or are they most concerned about retear rate? What is the ACL tear pattern, quality of tissue and length of time since injury? 

In my opinion, tear pattern, quality of tissue and type of athlete are the top predictors of whether ACL surgery with the BEAR technique is the best option in comparison to ACL reconstruction. In terms of tear pattern, ACL surgery with BEAR technique has even been indicated for what we call mid-substance tears. I'm still a little reluctant to use this implant and technique for mid-substance tears; however, further ongoing research in the form of high-quality trials and registries on the topic could change my mind.

After all of these factors are taken into account, the final plan comes down to a conversation with the patient about their reaction to the risks and benefits of all offered surgical techniques. The benefit of decreased scar tissue and decreased risk of long-term arthritis in the setting of acceptable retear rates, ACL surgery with the BEAR implant have been innovative technology that has been a game-changer for patients. In addition, these patients are more likely to have improved scores earlier in the rehab process, less contralateral ACL injuries and improved outcomes if they ever require a revision ACL surgery.

Q: Has anything surprised you in just this whole journey, either the patient outcomes, the surgical process or the new milestone?

DO: Given that my ACL repair journey started 10 years ago with internal ligament brace technology and now incorporates the ACL BEAR implant, I continue to be amazed with how well patients can do after surgery in the setting of clinical success, including acceptably low re-tear rates. We are blessed to have an opportunity to empower patients in their recovery by offering more options that can hopefully drive them toward a more successful outcome. 

Rothman Orthopaedics at AdventHealth is also thrilled to be on the cutting edge of this technology, which includes being the first practice and hospital in the world completing over 100 surgical procedures utilizing the BEAR implant. This collaboration between our adult and pediatric orthopedic sports medicine teams makes us very proud as we are able to offer more innovative surgical options to optimize recovery and outcomes for patients of all ages. 

Q: What are your predictions for biologic implants like BEAR in orthopedics? Do you think we'll see another breakthrough technology like BEAR?

DO: In orthopedic surgery, we are typically really good at optimizing biomechanics and stability; however, we have historically not been successful in finding options to enhance biological healing, especially in the ACL surgery space. Our journey into using biologics to optimize healing, recovery and outcomes in an evidence-based manner is the next frontier in orthopedic sports medicine. There are a plethora of biologics and scaffolds that are being proposed, and we need to be cautious about letting hope not outpace hype as we ultimately seek successful mid- and long-term outcomes and not just define success with short-term results. 

The other critical component of a successful recovery within the field of sports medicine is the importance of access to top-quality physical therapy and performance specialists as our patients progress through the phases of their nonsurgical or surgical journey. Despite doing great surgery in the setting of having biomechanical and biologic enhancement of the ACL repair, restoration or reconstruction site, physical therapy is critical to decrease pain, optimize performance and promote prevention for all desired activities.

Q: Is there anything else exciting going on with Rothman Orthopaedics Florida? 

DO: For Rothman Orthopaedics at AdventHealth, we started this partnership about two to three years ago, and we have made significant strides of transforming orthopedic care across Central Florida. We now have 33 physicians and surgeons located in eight offices throughout Central Florida who work collaboratively with an amazing administrative team to provide the highest quality of patient care. In fact, our physician and surgeon team is a group of nationally acclaimed academic leaders who are unique in that they are not only subspecialty fellowship trained, but each member also only treats patients within their subspecialty training. With this approach, our physician and surgeon group works as a team to help elevate orthopedic care for our community.

Q: Are there any other health trends or injuries that you're following closely right now?

DO: I am blessed to help take care of a lot of high-level athletes across a spectrum of different sports. My passion has been management of all athletes; however, my experience in baseball, including USA Baseball and Major League Baseball teams, as well as soccer, including the U.S. Soccer Men's National Team and Major League Soccer teams, I have developed a unique experience and interest in managing ACL injuries and throwing injuries. 

Within baseball, optimization of performance and prevention of injury have been critical in recent years. My team has been focused on working with innovative coaches, physical therapists, performance specialists and agents/advisers to ultimately improve care for these high-level athletes. At Rothman Orthopaedics at AdventHealth, we have a significant number of providers that have in-depth experience in baseball medicine and treating high-level baseball players. Along with ACL treatment and recovery, our team is proud to be on the forefront of also innovating in baseball medicine as we continue to push our field forward, providing better options with enhanced recovery and longevity back to the field.

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