Uploaded January 2026 | Updated September 2026, 1 week ago
In the final episode of this three-part series, Bruce A. Levy, MD (Orlando, FL), and Patrick A. Smith, MD (Naples, FL), provide a comprehensive summary of peer-reviewed, published clinical research documenting significantly reduced graft retear rates with the InternalBrace technique, including:
* Clinical outcome data from hundreds of young, high-risk ACL reconstruction patients, specifically examining the effects among those treated using hamstring, bone-tendon-bone, and quadriceps tendon autografts.
* Why conducting clinical research in young, higher-risk athletic patients was so essential to Dr. Smith’s work.
* A step-by-step technique walk-through and the importance of independent SutureTape fixation.
This episode marks the point where the research pyramid intersects with the patient. The focus is simple: does ACL reconstruction with the InternalBrace technique meaningfully reduce the ACL retear rate, especially in young athletes where failure is most devastating?
Dr. Smith explains why his clinical research centered on the highest-risk group. He cares for competitive athletes, and he points out that published outcomes in older, less active populations do not always translate to the teenagers and young adults who cut, pivot, and return to high-level sport. That framing drives the clinical outcomes review across graft types, follow-up windows, and return-to-play realities.
Dr. Smith provides a practical technique overview and emphasizes that the InternalBrace technique is independent of the graft, walking through the order of fixation to avoid over-constraint. He fixes the tape in full extension and hyperextension, then tensions the graft, cycles the knee to remove creep, and retensions. He explains that his goal is to achieve targeted protection where the risk resides, during near-extension cutting and pivoting, while maintaining controlled laxity in flexion.
Dr. Smith shows that a practice comparison of 200 patients with two-year follow-up showed a reduction from eight retears without the InternalBrace technique to one retear with the InternalBrace technique in a high-risk, young cohort. In a BTB graft group with a five-year follow-up, he reports zero retears with the internal brace versus five retears without, and addresses how reviewers challenged selection bias, prompting additional measurements such as tibial slope and graft position. In a cohort of 60 adolescent patients with quad tendon grafts and a three-year follow-up, he reports no retears and a return to sport at approximately 90% of the original level. For hamstring grafts, he shares the tougher reality of higher baseline failure rates, but still reports a meaningful reduction from 24% without augmentation to 5.6% with the InternalBrace technique at greater than four-year follow-up.
Dr. Smith also describes a human safety check using an MRI. In 25 quad graft patients, an independent musculoskeletal radiologist reviewed graft integrity and inflammation scoring, finding results consistent with what is reported for non-augmented grafts.
Finally, Dr. Smith discusses when he adds LET alongside the internal brace, including criteria like significant hyperextension and very high-risk profiles, such as female soccer players under 20.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period. It is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.
For more evidence, to hear from leading surgeons, or to explore upcoming episodes, please like the video, leave a comment, and subscribe to the Arthrex - What's New in OrthoPedics YouTube channel.
👉 Learn more about ACL reconstruction and Arthrex's surgical innovations:
arthrex.com/knee
acltear.com
📢 If you want to see more evidence, hear from leading surgeons, or explore upcoming episodes, make sure to like the video, leave a comment with your questions, and subscribe to the Arthrex YouTube channel.
#ACLReconstruction #ACLReconstruction #InternalBrace #Arthrex #SportsMedicine #kneesurgerysuccess
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: linkedin.com/company/arthrex
Facebook: facebook.com/Arthrex
Instagram: instagram.com/arthrex_inc
X: https://x.com/arthrex
In the final episode of this three-part series, Bruce A. Levy, MD (Orlando, FL), and Patrick A. Smith, MD (Naples, FL), provide a comprehensive summary of peer-reviewed, published clinical research documenting significantly reduced graft retear rates with the InternalBrace technique, including:
* Clinical outcome data from hundreds of young, high-risk ACL reconstruction patients, specifically examining the effects among those treated using hamstring, bone-tendon-bone, and quadriceps tendon autografts.
* Why conducting clinical research in young, higher-risk athletic patients was so essential to Dr. Smith’s work.
* A step-by-step technique walk-through and the importance of independent SutureTape fixation.
This episode marks the point where the research pyramid intersects with the patient. The focus is simple: does ACL reconstruction with the InternalBrace technique meaningfully reduce the ACL retear rate, especially in young athletes where failure is most devastating?
Dr. Smith explains why his clinical research centered on the highest-risk group. He cares for competitive athletes, and he points out that published outcomes in older, less active populations do not always translate to the teenagers and young adults who cut, pivot, and return to high-level sport. That framing drives the clinical outcomes review across graft types, follow-up windows, and return-to-play realities.
Dr. Smith provides a practical technique overview and emphasizes that the InternalBrace technique is independent of the graft, walking through the order of fixation to avoid over-constraint. He fixes the tape in full extension and hyperextension, then tensions the graft, cycles the knee to remove creep, and retensions. He explains that his goal is to achieve targeted protection where the risk resides, during near-extension cutting and pivoting, while maintaining controlled laxity in flexion.
Dr. Smith shows that a practice comparison of 200 patients with two-year follow-up showed a reduction from eight retears without the InternalBrace technique to one retear with the InternalBrace technique in a high-risk, young cohort. In a BTB graft group with a five-year follow-up, he reports zero retears with the internal brace versus five retears without, and addresses how reviewers challenged selection bias, prompting additional measurements such as tibial slope and graft position. In a cohort of 60 adolescent patients with quad tendon grafts and a three-year follow-up, he reports no retears and a return to sport at approximately 90% of the original level. For hamstring grafts, he shares the tougher reality of higher baseline failure rates, but still reports a meaningful reduction from 24% without augmentation to 5.6% with the InternalBrace technique at greater than four-year follow-up.
Dr. Smith also describes a human safety check using an MRI. In 25 quad graft patients, an independent musculoskeletal radiologist reviewed graft integrity and inflammation scoring, finding results consistent with what is reported for non-augmented grafts.
Finally, Dr. Smith discusses when he adds LET alongside the internal brace, including criteria like significant hyperextension and very high-risk profiles, such as female soccer players under 20.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period. It is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.
For more evidence, to hear from leading surgeons, or to explore upcoming episodes, please like the video, leave a comment, and subscribe to the Arthrex - What's New in OrthoPedics YouTube channel.
👉 Learn more about ACL reconstruction and Arthrex's surgical innovations:
arthrex.com/knee
acltear.com
📢 If you want to see more evidence, hear from leading surgeons, or explore upcoming episodes, make sure to like the video, leave a comment with your questions, and subscribe to the Arthrex YouTube channel.
#ACLReconstruction #ACLReconstruction #InternalBrace #Arthrex #SportsMedicine #kneesurgerysuccess
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: linkedin.com/company/arthrex
Facebook: facebook.com/Arthrex
Instagram: instagram.com/arthrex_inc
X: https://x.com/arthrex
