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InternalBrace™  surgery

An innovative surgical method of ligament repair and reconstruction that can speed up recovery by 50%

InternalBraceTM surgery is an innovative surgical method of ligament repair and reconstruction that can be used even for late presentation cases. The InternalBraceTM protects the ligaments and tendons during the healing process, meaning it speeds up recovery time by up to 50% (this will depend on the individual patient). 

Traditionally, people who have had tendon or ligament reconstruction surgery would be encouraged to take it easy for a while. Patients who are treated using the InternalBraceTM method experience an enhanced recovery programme. They’re encouraged to start moving immediately after surgery and to begin a rehabilitation process that has been shown to result in a faster recovery and a quicker return to work, sports and other activities. 

InternalBraceTM surgery (also referred to as suture tape augmentation) is a significant step forward in ligament and tendon repair. The brace is a length of biocompatible polymer that is attached internally to the damaged ligament or tendon. It takes advantage of the body’s ability to heal itself by offering protection to the damaged area while this natural healing takes place.

Unlike a traditional reconstruction, it does not involve drilling unduly large tunnels into your bones. Nor is immobilisation (staying still) required after surgery. In fact, patients are encouraged to mobilise immediately. While the patient is gradually increasing the intensity and duration of exercise, the ligament/tendon grows through the lattice structure of the InternalBraceTM, which acts as a seatbelt, supporting the regeneration and healing of the injured tissue.

There are many benefits to patients when we use InternalBraceTM in surgery. The main advantages are the decreased recovery times and the avoidance of certain side-effects of more traditional methods. For example, the chance of muscle wastage and potential arthritic damage or changes (due to long periods of immobilization or inactivity) are reduced when using this advanced method. Also, because patients do not need to wear an external brace or cast, they experience less pain and better levels of comfort during the recovery period. 

Will I still need a graft of some sort?

InternalBraceTM repair surgery is often carried out without the need to use a graft of donor tissue. However, sometimes in cases of severe ligament or tendon damage, there is not enough natural tissue left to allow it to heal. In such cases a hybrid InternalBraceTM repair and graft is needed. 

In 90% of cases where such a hybrid procedure is needed, we are able to use a much smaller graft than would be used in a traditional reconstruction. Again, this has benefits for patient recovery and long-term strength.

The InternalBraceTM technique was invented and developed by Professor Gordon Mackay, a world-leading Orthopaedic Consultant and specialist Sports Surgeon.

Professor Mackay sees private patients at Ross Hall Hospital in Glasgow and Kings Park Hospital in Stirling. Patients travel from all over the UK and abroad to see Professor Mackay.

Most InternalBraceTM surgery can be carried out using a keyhole procedure known as an arthroscopy. During the operation one or two small incisions are made near the affected ligament or joint.

Through these small incisions a camera is inserted, along with small surgical instruments. Your Surgeon can then see inside your joint and perform treatment without having to ‘open’ it up. 
Only in more complex cases will the surgeon a more extensive or ‘open’ approach to your reconstructive surgery. This will be discussed at your consultation.

Many ligament and tendon reconstruction surgeries are performed arthroscopically, so the use of ‘keyhole’ surgery is not a new technique. The difference with the InternalBraceTM is that, instead of removing the damaged area, we instead support it with the specially designed suture tape, allowing it to heal and recover in its original position.

Due to the nature of this internal protection, following surgery there will be no need to be in a cast or wear an external support or brace.

What problems or injuries can be treated with InternalBraceTM surgery?

While by no means an exhaustive list, InternalBraceTM surgery is often used for the following injuries/conditions:

Shoulder procedures

AC joint reconstruction surgery
Distal biceps repair surgery

Ankle procedures

Ligament repair and reconstruction surgery
Including lateral ligaments, medial deltoid ligament and syndesmosis
Achilles tendon repair surgery


Foot procedures

Lisfranc dislocation – torn ligaments in midfoot
Bunion surgery
Soft tissue balancing and toe alignment


Wrist and hand procedures

Ligament repair and reconstruction surgery
Thumb dislocation (gamekeepers thumb)
Scapholunate wrist dislocation
Fracture dislocation of fingers

InternalBraceTM surgery can be used to treat any ligament or tendon damage. So, although it was initially developed with sports injuries in mind, it is now used on patients of all ages from all walks of life – transforming patient experience and recovery.

Now any patient can take advantage of this advanced surgical technique, developed initially to advance recovery in high level sports injuries in, for example, footballers, Olympians, and baseball players.

Today, the procedure is recognised and used worldwide, and patient outcomes prove that this method can offer a faster and more successful recovery in nearly all tendon and ligament injuries. 

So, whether you suffered an injury as a professional sportsperson, by lifting something in the home, or simply tripped while walking the dog, the InternalBraceTM technique can be used to enhance your recovery, getting you back to work, activity or sport more quickly.

Compared to pre-existing methods available for tendon and ligament repairs, the main benefits of the InternalBraceTM are that it reduces recovery time and that it can avoid the potential side effects of traditional surgical procedures, which require a period of immobility during the healing process.

This technique allows for early mobilisation of the affected joint, which has been shown to promote faster recovery times and can promote better long-term outcomes in terms of function.

For you, the advantages of InternalBraceTM surgery compared to other methods include:

A faster return to work and sport

The unique procedure leads to very little loss of function, meaning patients can return to sport, work and activities more quickly than with other methods. Recovery time is generally reduced by 50%.

A better chance of regaining full strength and balance in the affected joint long-term

The aim of this procedure is to have you feeling just as good and to be as strong as you were prior to injury. Clinical research in the case of knee surgery comparing traditional reconstructions to InternalBraceTM repair surgery shows great long-term improvement in the case of the latter patients.

A faster return to normal function

Feel like you again. Faster. For example:

InternalBraceTM ankle ligament repair immediately restores full strength, equivalent to the uninjured side
Most knee ligament repair patients can start bear weight on the day of surgery
ACL repair patients can regain 90% of function 12 weeks after surgery

A lower chance of side-effects after surgery

Many risks associated with surgical procedures are actually due to how immobile people are forced to be during the initial recovery period. 

Because the InternalBraceTM method does not include any period of restricted movement, the risks of muscle wasting, blood clots and further joint damage are all reduced. 

Shorter procedures are associated with lower risk of infection

The risk of infection is present during every surgical procedure, but gets smaller the shorter the operation is. 

A potentially lower risk of arthritis following injury

The InternalBraceTM technique was designed as a minimally invasive augmentation to preserve natural tissue with the hope of minimising the risk of osteoarthritis. This is increasingly borne out by patient clinical follow-up data.

Benefits of specific procedures

In particular cases the benefits are more specific. Patients undergoing AC joint reconstruction surgery with InternalBraceTM augmentation are far less likely to be left with the residual horizontal instability normally experienced by 40% of patients after traditional procedures.

Before surgery

Before your operation, your Consultant Surgeon will take the time to talk you through everything and confirm that you are a suitable candidate for InternalBraceTM surgery. Then they will discuss all that’s involved, from what to expect on the day, to any potential risks of the procedure, to a timeline for recovery.

You will be told when to come to hospital, what to bring with you, and how long we expect your stay to be.

On the day of surgery, your Consultant will come to chat to you before the procedure, to answer any last-minute questions you may have. Your Anaesthetist and Theatre Nurse may also come to introduce themselves, so that you feel comfortable when you go into Theatre.

During the operation

Most ligament surgery is done under general anaesthetic, which means you will be asleep the whole time.

Your Surgeon will begin the procedure by making one or two small incisions around the damaged area. For example, for ACL reconstruction or repair surgery, they will make the incisions into your knee.

They will then pass a tiny camera, known as an arthroscope, in through these incisions. An image of the inside of your joint will be projected onto a screen so that they can see what they are doing.

The same small incisions will be used to insert specially designed surgical instruments, as well as the InternalBraceTM, which will be attached to the damaged ligament or tendon. Depending on your injury, your Surgeon may also perform other repairs during the same procedure.

Once the procedure is complete, you will be taken to your private room to start your recovery in comfort.

After surgery

Depending on your personal circumstances and on what procedure you have, you may be able to go home on the same day as your surgery, or you may need to stay in hospital for one night.

A physiotherapist will also come to see you before you leave hospital to talk over any exercises that you should do and when to start them, as you begin your recovery and rehabilitation.

Once home, you should follow your physiotherapist’s instructions, which will be different for every person. Still, most patients are able to begin to move around immediately without the immobilising effects of a hard plaster cast. In some instances, though, you may be given a protective boot to wear for the first few weeks.

InternalBraceTM surgery refers to several different procedures, each of which use InternalBraceTM technology. Your recovery will be different depending on the nature and severity of your injury and the subsequent procedure you had, as well as differing from person to person. Your Consultant will give you a projected recovery timeline based on your personal circumstances. 

What is the same for all InternalBraceTM patients is that your recovery should be faster and less painful than from more traditional surgical methods.

Ross Hall Hospital has found that patients can return to work and get back to playing sports as much as 50% quicker when the InternalBraceTM is used. 

InternalBraceTM surgery is a highly successful procedure, but there are always risks that come with any surgery or invasive process. These will include bleeding, bruising and the possibility of infection. Arthroscopic surgery minimises, but does not exclude, all of these. 

There is also the possibility of nerve damage, which can lead to numbness in the future.

Suture tape itself is made from the same material as non-dissolving stitches and decades of experience show that this is inert with respect to the human body and extremely well tolerated.

The major risk of InternalBrace™ surgery, after the usual ones of any surgical procedure, is that it doesn't work. This does happen. Very occasionally, even with the aid of the InternalBraceTM, those natural repair processes don't in fact heal. Or perhaps the patient re-injures the same joint.

In this instance, the advantage of the InternalBraceTM procedure is that, because it is much less invasive than traditional surgical methods, nothing has been done that rules out using a more traditional technique afterwards, should this be necessary. Having had InternalBraceTM surgery doesn’t stop you from trying any of the other options. In this respect it is viewed as a ‘no regrets’ first resort option by patients.

There will also be a few risks or possible side effects relating to the specific type of ligament repair or tendon repair that you are undergoing. Your Surgeon will explain all of these before you have the operation, and you should feel free to ask as many questions as you like.

The price for every patient will be different, because we create a tailored treatment plan for every person we see. In your initial consultation, we will begin by learning as much as possible about you and your condition or injury. Your Consultant will use this information to advise on the best course of treatment, though the final decision is always yours to make. 

After that, our team will build a bespoke treatment package for you, which will have a fixed price. You will know ahead of time exactly how much your surgery is going to cost.

When you choose to have your ligament or tendon surgery with us, your treatment will be led by Professor Mackay, the inventor of the InternalBraceTM.

If you have surgery using his InternalBraceTM method, you are choosing the most effective form of tendon and ligament repair surgery currently in use worldwide.

As well as access to the latest surgical techniques, there are many advantages to be had when you choose private healthcare at Ross Hall Hospital, including:

Consultant-led care from a team of orthopaedic and sports injury specialists
A bespoke treatment plan built around your individual needs
Private, en-suite rooms with TV, WiFi and a direct line telephone
A 24-hour nurse call system, just in case
On-site diagnostics, pharmacy and physiotherapy should you need extra support during your stay with us
Delicious food cooked in-house to your dietary requirements
Free parking for every patient

Specialists offering Internal brace

Mr Willem Schenk

Consultant Orthopaedic Surgeon

Bachelor of Medicine, Master of Surgery, Fellow of the Royal College of Surgeons

BMI St Edmunds Hospital

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Mr Shilpith Shetty

Consultant Orthopaedic & Trauma Surgeon

MBBS, M.S(Orth), DNB(Orth), MCh.Orth(Liverpool), FRCS-Tr & Orth(London)

BMI Sarum Road Hospital

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Mr William Ryan

Consultant Orthopaedic Surgeon

MD FRCS FRCS (Orth)

BMI The Alexandra Hospital 1 more BMI The Beaumont Hospital

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Mr David Hollinghurst

Consultant Orthopaedic Surgeon

MA (Cantab), MB B chir, FRCS (Tr & Orth)

BMI The Ridgeway Hospital

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Mr Nitin Badhe

Consultant Orthopaedic Surgeon

FRCS(Orth), Mch Orth, MS Orth, DNB Orth, FCPS Orth, D’Orth, MRCS Surg

BMI The Park Hospital

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