Uploaded January 2026 | Updated September 2026, 2 weeks ago
In the second episode of this three-part series, Bruce A. Levy, MD (Orlando, FL), and Patrick A. Smith, MD (Naples, FL), explore the peer-reviewed, published biomechanical research evaluating the concept of load sharing and how the InternalBrace™ technique impacts displacement, load, and stiffness for different graft sizes and types, including:
* Biomechanical features of FiberTape® suture
* The importance of independent fixation to create a load-sharing construct to avoid stress shielding
* Dr. Smith's first biomechanical model, in which he explored how adding the InternalBrace technique impacts displacement as compared to grafts alone
The conversation begins with the earliest biomechanical work evaluating how FiberTape elongates under load. Dr. Smith explains the sweet spot of the material. When loaded to 400 newtons, FiberTape lengthens approximately four millimeters. This elasticity shows that the tape is not a rigid cable, but a material that allows the ACL graft to withstand meaningful loads during healing. The goal is to protect the graft, not overpower it.
The discussion then shifts to the key 2017 study that compared small-diameter grafts to larger grafts. Smaller grafts, especially those measuring eight millimeters or less, have higher failure rates in the published literature. The team tested grafts at 250 and 400 newtons and evaluated how the constructs behaved with and without the InternalBrace technique. Both the graft alone and the tape alone showed displacement. Yet when combined, the construct remained within what the literature refers to as the ACL functional zone. This testing was the first significant demonstration of the load sharing effect.
The episode also addresses an important point that often arises for clinicians: stress shielding. Dr. Smith and the Arthrex engineering team conducted a study using optical tracking to measure exactly when the tape engages. They placed one millimeter of laxity in the tape, just as done clinically. The research showed that the graft always carries the majority of the load, with the tape engaging only at higher loads. In smaller diameter grafts, the tape supports a load of around 200 newtons. In larger grafts, the tape engages at a force closer to 300 newtons. This study confirmed that the InternalBrace technique does not unload or shield the graft, but instead supports it under high-demand conditions.
The episode then turns to BTB grafts, which are considered the gold standard by many surgeons. The team found that adding the InternalBrace technique decreased cyclic displacement by 31% and increased overall construct stiffness. The positive biomechanical effect was observed with both soft tissue grafts and patellar tendon grafts.
Dr. Smith also clarifies the difference between FiberTape and SutureTape, noting that some published papers use the term "suture tape" due to trademark requirements. In mechanical testing, the 2.0 mm Arthrex FiberTape consistently outperformed the smaller 1.3 mm suture tape.
The episode closes with a discussion of how these biomechanical findings translate to real patients. Early in rehabilitation or in cases of non-compliance, the tape protects the graft during high-load moments that could otherwise lead to elongation or failure.
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.
👉 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 second episode of this three-part series, Bruce A. Levy, MD (Orlando, FL), and Patrick A. Smith, MD (Naples, FL), explore the peer-reviewed, published biomechanical research evaluating the concept of load sharing and how the InternalBrace™ technique impacts displacement, load, and stiffness for different graft sizes and types, including:
* Biomechanical features of FiberTape® suture
* The importance of independent fixation to create a load-sharing construct to avoid stress shielding
* Dr. Smith's first biomechanical model, in which he explored how adding the InternalBrace technique impacts displacement as compared to grafts alone
The conversation begins with the earliest biomechanical work evaluating how FiberTape elongates under load. Dr. Smith explains the sweet spot of the material. When loaded to 400 newtons, FiberTape lengthens approximately four millimeters. This elasticity shows that the tape is not a rigid cable, but a material that allows the ACL graft to withstand meaningful loads during healing. The goal is to protect the graft, not overpower it.
The discussion then shifts to the key 2017 study that compared small-diameter grafts to larger grafts. Smaller grafts, especially those measuring eight millimeters or less, have higher failure rates in the published literature. The team tested grafts at 250 and 400 newtons and evaluated how the constructs behaved with and without the InternalBrace technique. Both the graft alone and the tape alone showed displacement. Yet when combined, the construct remained within what the literature refers to as the ACL functional zone. This testing was the first significant demonstration of the load sharing effect.
The episode also addresses an important point that often arises for clinicians: stress shielding. Dr. Smith and the Arthrex engineering team conducted a study using optical tracking to measure exactly when the tape engages. They placed one millimeter of laxity in the tape, just as done clinically. The research showed that the graft always carries the majority of the load, with the tape engaging only at higher loads. In smaller diameter grafts, the tape supports a load of around 200 newtons. In larger grafts, the tape engages at a force closer to 300 newtons. This study confirmed that the InternalBrace technique does not unload or shield the graft, but instead supports it under high-demand conditions.
The episode then turns to BTB grafts, which are considered the gold standard by many surgeons. The team found that adding the InternalBrace technique decreased cyclic displacement by 31% and increased overall construct stiffness. The positive biomechanical effect was observed with both soft tissue grafts and patellar tendon grafts.
Dr. Smith also clarifies the difference between FiberTape and SutureTape, noting that some published papers use the term "suture tape" due to trademark requirements. In mechanical testing, the 2.0 mm Arthrex FiberTape consistently outperformed the smaller 1.3 mm suture tape.
The episode closes with a discussion of how these biomechanical findings translate to real patients. Early in rehabilitation or in cases of non-compliance, the tape protects the graft during high-load moments that could otherwise lead to elongation or failure.
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.
👉 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
