At the Mackay Clinic, Professor Gordon Mackay uses InternalBrace augmentation where appropriate to support knee ligament repair and reconstruction. As the inventor of the technique and a contributor to ongoing research, he combines clinical experience with published evidence. Below, we highlight three studies exploring outcomes after ACL reconstruction with InternalBrace, including repeat surgery, re-rupture and return to sport.
ACL Reconstruction with InternalBrace: What the Research Shows
Published studies have explored how InternalBrace suture tape augmentation may support ACL reconstruction. Here we highlight three studies examining repeat surgery, graft re-rupture and return to sport.
These findings relate to ACL reconstruction, where a graft replaces the injured ligament. They should not be applied directly to ACL repair or every type of knee surgery.
88% lower rate of repeat ACL reconstruction in one comparative study
Daniel, Wijdicks and Smith - 2023
This study compared 100 patients who underwent ACL reconstruction with Internal Brace augmentation with 100 matched patients treated without it. Patients were aged 13–39, with at least two years of follow-up.
Repeat ACL reconstruction was required in 1% of the Internal Brace group compared with 8% of the group without augmentation—an approximately 88% relative reduction in revision surgery.
The findings are encouraging, but the study was observational rather than randomised, and the group without Internal Brace had a longer average follow-up. It measured repeat reconstruction surgery, rather than every possible re-injury.
Read the IBISG research summary · View the original study
1.1% graft re-rupture rate at an average five-year follow-up
Wilson, Kennedy, MacLeod, Hopper and Mackay - 2023
This study, co-authored by Professor Gordon Mackay, examined ACL reconstruction using hamstring or patellar tendon grafts reinforced with independently tensioned suture tape.
Among 90 patients contactable at an average of five years after surgery, one graft re-rupture was recorded, giving a rate of 1.1%. Patient-reported knee function also improved following treatment.
These results provide encouraging medium-term evidence. However, the study had no comparison group, so it cannot establish how much the augmentation contributed to the low re-rupture rate.
Read the IBISG research summary · Read the original study
90% returned to sport at the same level in a young-athlete study
Daniel and Smith - published in 2025
This study examined 60 skeletally mature high-school and college athletes who underwent ACL reconstruction using a quadriceps tendon graft with suture tape augmentation, with at least two years of follow-up.
54 athletes-90%-returned to sport at the same level. The remaining six did not return at that level because of graduation.
The result relates to a specific graft technique and young athletic population. As an uncontrolled case series, it does not demonstrate that InternalBrace alone produced the return-to-sport rate.
What these findings mean for patients
These figures come from separate studies involving different patients, techniques and follow-up periods. They are not the Mackay Clinic’s overall outcome rates or a guarantee of individual results. Treatment and rehabilitation are tailored to each patient’s injury, circumstances and activity goals.
Discover more Internal Brace research
Explore the Internal Brace International Study Group (IBISG) Research Library for more published studies, accessible summaries and links to original papers. Search and filter the collection by body area, ligament structure and study type.