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Internal brace

Supports and protects the damaged ligament while retaining joint movement

Internal Brace surgery, more correctly InternalBrace™ surgery, is the swiftest and most effective form of tendon and ligament repair surgery currently in use. The essence of InternalBrace™ is to support and protect the damaged ligament while retaining joint movement.

This allows the body's own healing processes to work. The effect is to substantially reduce recovery time and the muscle wastage that can result from older methods of ligament repair or replacement.

An alternative description of InternalBrace™ is suture tape augmentation, although this is not strictly correct. InternalBrace™ is the original treatment and the specific technique. Suture tape augmentation is a description of what is done in more general terms.

Which is to support a torn, stretched, or otherwise damaged tendon or ligament with a mesh of suture tape. This allows the joint to still flex and move while protecting the damaged area. The effect is to enable recovery without the damage associated with long term immobility of a joint or limb.

It also allows the body's own regenerative processes to heal the original damage.

InternalBrace™ is the preferred treatment for almost any ligament or tendon damage. It was originally developed to treat high level sports injuries, for footballers, Olympians and the like. A decade of experience shows that the application can be much wider than that. Anterior cruciate ligaments, when torn or damaged, benefit from InternalBrace™ treatment, this being where it was pioneered.

Experience shows that near any tear or damage to ligaments can be treated in this way. The stretch and weakness from a dislocation of a joint for example. Congenitally weak ankles have been successfully treated. The ruptured Achilles tendon of an Olympic bobsleigh athlete was repaired in time to join the competition. A thumb tendon in an American football quarterback. The ligaments of a Masters golfer after a knee dislocation. While originating in the treatment of such sporting injuries, InternalBrace™ can now be used on all such ligament and tendon trauma.

Human joints are largely held together by a series of tendons and ligaments. Some can become damaged, tear or stretch, on their own. Others, such as the Achilles, can and will rupture, as will the hamstrings. Near any joint dislocation will lead to the stretching and weakening of the associated tendons and therefore also of the future functionality of the joint.

InternalBrace™ is the initial treatment of choice for all of these problems. It is not just that the final result, in terms of joint usage recovery, is better. It is that the recovery time is significantly reduced as well. Anyone hoping to return to work or sport, or even just normal daily life, swiftly after joint injury should be considering the treatment. 

The requirement for InternalBrace™ treatment is that there be either tendon or ligament damage which requires repair or restoration. Plus the desire to use the currently best available treatment for that damage.

Whether or not InternalBrace™ is the treatment of choice for a specific injury really depends upon the one question. Is the injury to a tendon or ligament? Then yes, it should at least be discussed.

InternalBrace™, or suture tape augmentation, employs arthroscopic surgery. This is also known as keyhole surgery. A small incision is, possibly two are, made near the affected joint or tendon. This allows the introduction of the surgical instrument and also an optical fibre to allow visual inspection to the surgeon.

This is also the way that earlier techniques like ligament replacement or transplant were done. But InternalBrace™ is a system of augmentation, meaning that instead of extracting a tendon from elsewhere in the body to replace that injured the original is left in place and aided to recover.

InternalBrace™ works better soon after the initial injury. The aim, the technique, is to bolster the body's recovery process by supporting it.

Therefore, treatment works better earlier in that process of the body attempting repair. Waiting until the natural process is complete, or abandoned, is going to reduce the effectiveness and other treatment methods might be more appropriate.

Up to three months after the original problem is a useful estimate of the greatest effectiveness of suture tape augmentation.

The effect of minimising surgical intervention plus reducing the necessary immobility of the joint after other repair methods means that recovery time is significantly reduced. It is usually possible, for example, for a knee to bear weight the day after an operation.

Full recovery time will vary from patient to patient but is far quicker with the InternalBrace™ method that alternatives. The ability to drive depends a little but is usually advised between 7 and 28 days after, say, knee surgery. This does depend upon which knee and the use or not of an automatic.

A reasonable but not perfect – for outcomes differ across patients – is that the recovery time from suture tape augmentation is around half that from other procedures to repair the same damage to tendons or ligaments.

 For example, a typical Achilles treatment is still to immobilise the entire joint in a cast for considerable time. This will cause muscle wastage and increases the possibility of osteoarthritis in the future. It is the side effects of this treatment which will extend recovery time beyond that of InternalBrace™

A common question is whether recovery can be accelerated. One answer is that treatment is just going to takes its time, a more correct one is that treatment with suture tape is accelerating that recovery time. Any surgical treatment will require recovery, how much recovery dependent upon which treatment.

The recovery time to getting back to sport, or sustained effort and exercise, will depend upon the specific injury that was treated. One detail is that the suture tape protects the tendon while movement is resumed. In opposition to the effect of a brace or other constraint, which prevents movement at all by design.

This shortens overall recovery time back to normal.

There are risks to any surgery or invasive process. These will include bleeding, bruising, 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. There are no known allergic reactions.

The major risk of InternalBrace™, after the usual ones of any surgical procedure, is that it doesn't work. This does happen. Simply that those natural repair processes, even with the aid being given, don't in fact deal with the problem.

The advantage here is that, in this sense, InternalBrace™ is a “no regrets” treatment. The older, more invasive and involved treatments can still be tried afterwards.

Replacement of tendons, transplants, joint immobilisation for significant periods, these are not ruled out by previously having tried suture tape augmentation.

Specialists offering Internal brace

Mr Toby Briant-Evans

Consultant Orthopaedic Surgeon

B Med Sci, BM BS, FRCS (Tr & Orth)

BMI The Hampshire Clinic

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Mr Ghias Bhattee

Consultant Orthopaedic Surgeon

MB BS, MRCS, FRCS(Tr&Orth)

BMI The Clementine Churchill Hospital

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Mr Hinesh Bhatt

Consultant Orthopaedic Surgeon

FRCS(Tr&Ortho), M.S(Ortho)

BMI Bishops Wood Hospital 1 more BMI The Clementine Churchill Hospital

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Professor Mark Wilkinson

Consultant Orthopaedic Surgeon

MB ChB, PhD, FRCS (Orth)

BMI Thornbury 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 Samir Nabil Massoud

Consultant Orthopaedic Surgeon

MCChB FRCSI FRCSI (orth)

BMI The Droitwich Spa Hospital 1 more BMI The Priory Hospital

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