Institutional review board and US Food and Drug Administration approval to conduct the trial was obtained before the start of the BEAR II Trial (IDE G150268, IRB P00021470). All patients granted their informed consent. Between May 2016 and June 2017, 100 patients (ages, 13-35 years) who had a complete ACL tear, were <45 days from injury, had closed physes, and had at least 50% of the length of the ACL attached to the tibia were randomized in an approximate 2:1 ratio to undergo either the implant-enhanced ACL repair procedure (ie, BEAR; 65 patients) or autograft ACLR (35 patients) (Figure 2). A permuted block randomization scheme was used with block sizes of 3 and 6. Randomization was stratified by the surgeon’s preference for autograft source (hamstring tendon or bone–patellar tendon–bone) and administered by the research coordinators using sealed envelopes from the statistician. Patients were excluded if they had a history of ipsilateral knee surgery, previous knee infection, or risk factors that could adversely affect ligament healing (nicotine/tobacco use, corticosteroid use in the past 6 months, chemotherapy, diabetes, inflammatory arthritis). Patients were excluded if they had a displaced bucket-handle tear of the medial meniscus requiring repair; patients with any other meniscal injuries were included. Patients were excluded if they had a full-thickness chondral injury, a grade III medial collateral ligament injury, a concurrent complete patellar dislocation, or a posterolateral corner injury requiring operative treatment. All patients were enrolled at Boston Children’s Hospital, and patient recruitment was completed over 12 months.