Illustration of a knee with an internal brace and question marks, symbolizing uncertainty about ACL repair outcomes.

ACL Repair Revolution: Are Internal Braces the Answer for Young Athletes?

Theo Raines in Health & Wellness November 2025 • 4 min read.

"A new study reveals the high failure rate of internal brace ACL repair in young athletes, sparking debate over the best surgical approach."

Anterior cruciate ligament (ACL) injuries are common among young athletes, often requiring surgical intervention. Traditional ACL reconstruction, using grafts to replace the torn ligament, has been the gold standard. However, a newer technique, internal brace ACL repair, aims to preserve the original ligament with the help of an internal brace for added support.

Internal brace ACL repair has gained popularity due to its potential for faster recovery and a less invasive approach. But is it truly the best option for young, active individuals? Recent research is shedding light on the effectiveness of this technique compared to traditional reconstruction.

This article dives into a study that compared internal brace ACL repair to traditional ACL reconstruction (using quadriceps tendon patellar autograft, or QPA) in adolescent athletes. We'll explore the findings, discuss the implications, and help you understand the risks and benefits associated with each approach.

Internal Brace ACL Repair: Promising Technique, Concerning Failure Rates

Illustration of a knee with an internal brace and question marks, symbolizing uncertainty about ACL repair outcomes.

The study, presented at the 2018 AOSSM Annual Meeting, focused on adolescent and pediatric subjects who underwent primary ACL reconstruction or repair with internal brace augmentation between January 2013 and January 2016. Researchers compared outcomes of 19 patients who received internal brace ACL repair with 132 patients who underwent QPA reconstruction. All subjects had a minimum of 6 months of follow-up.

The results revealed a significant difference in failure rates within the first two years post-surgery. While the cumulative incidence of failure was only 3.8% (5 out of 132) in the QPA group, it was a startling 52.6% (10 out of 19) in the internal brace repair group.

Higher Failure Rate: Internal brace repair showed a significantly higher failure rate compared to traditional reconstruction.
Younger Age: The repair group tended to be younger, with an average age of 14.1 years compared to 15.5 years in the reconstruction group.
Joint Laxity: KT-1000 side-to-side joint laxity measures were significantly higher in the repair group, indicating greater instability.

These findings raise concerns about the long-term effectiveness of internal brace ACL repair, particularly in young athletes who place high demands on their knees. While the technique aims to preserve the original ligament, the study suggests it may not provide sufficient stability in all cases.

Making Informed Decisions: What Does This Mean for Young Athletes?

The study emphasizes the importance of carefully considering the risks and benefits of internal brace ACL repair versus traditional reconstruction, especially for young athletes. While internal brace repair may offer potential advantages like faster recovery, the high failure rate observed in this study suggests it may not be the most reliable option for everyone.

Factors such as age, activity level, and individual knee stability should be taken into account when deciding on the best surgical approach. A thorough discussion with an experienced orthopedic surgeon is crucial to determine the most appropriate treatment plan.

While further research is needed to fully understand the long-term outcomes of internal brace ACL repair, this study serves as a valuable reminder that no surgical technique is without risk. A personalized approach, based on individual needs and circumstances, is essential for successful ACL injury management in young athletes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1177/2325967118s00068, Alternate LINK

Title: Internal Brace Acl Repair Is Associated With High Failure Rate In The First Two Years Post-Surgery

Subject: Orthopedics and Sports Medicine

Journal: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications

Authors: Alexia Georgia Gagliardi, Patrick M. Carry, Ariel Kiyomi Daoud, Harin Bhavin Parikh, Jay C. Albright

Published: 2018-07-01

Everything You Need To Know

What is internal brace ACL repair, and how does it differ from traditional ACL surgery?

Internal brace ACL repair is a surgical technique that aims to preserve the original anterior cruciate ligament (ACL) by using an internal brace for added support. The goal is to provide a less invasive approach with the potential for faster recovery compared to traditional ACL reconstruction. However, recent studies suggest it may have higher failure rates, especially in young, active individuals.

What is traditional ACL reconstruction with a quadriceps tendon patellar autograft (QPA)?

Traditional ACL reconstruction involves replacing the torn anterior cruciate ligament (ACL) with a graft. One common method uses a quadriceps tendon patellar autograft (QPA). This technique has been the gold standard for ACL injuries, and the study mentioned compared it to internal brace ACL repair to evaluate the effectiveness of each approach.

What did the study reveal about the failure rates of internal brace ACL repair versus traditional ACL reconstruction?

The study indicated that internal brace ACL repair had a significantly higher failure rate (52.6%) compared to traditional ACL reconstruction using quadriceps tendon patellar autograft (QPA) (3.8%) within the first two years post-surgery. Additionally, patients who underwent internal brace ACL repair tended to be younger and exhibited greater joint laxity, indicating less stability.

What are the potential implications of a higher failure rate in internal brace ACL repair for young athletes?

The higher failure rate of internal brace ACL repair, as observed in the study, raises concerns about its long-term effectiveness, especially for young athletes who place high demands on their knees. While it may offer the appeal of a faster recovery, the study implies that internal brace ACL repair might not provide sufficient stability in all cases, necessitating careful consideration of its suitability for each patient.

What factors should young athletes and their families consider when choosing between internal brace ACL repair and traditional ACL reconstruction (QPA)?

When deciding between internal brace ACL repair and traditional ACL reconstruction (using quadriceps tendon patellar autograft, or QPA), it's crucial to consider the risks and benefits of each approach. For young athletes, the study suggests that while internal brace ACL repair may offer faster recovery, its higher failure rate should be carefully weighed against the more proven stability offered by traditional reconstruction. Factors such as age, activity level, and individual knee stability should be taken into account during the decision-making process, in consultation with a qualified orthopedic surgeon.