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2026 ACE AWARD SUBMISSION

Primary ACL repair for surgeon pioneers.

Native Orthopaedics delivers dynamic tensioning, metal-free fixation, and surgical simplicity — solving the tradeoffs that have defined ACL repair for decades.

WHY REPAIR

Reconstruction is the standard of care — but the outcomes tell a different story.

Repair preserves what reconstruction cannot.

Native Orthopaedics — Stat Cards (Light)
3x
worse joint position sense accuracy with reconstruction vs. primary repair
In a direct head-to-head comparison, deviation angles measuring proprioceptive accuracy were ~2.7° in the reconstruction group vs. ~1.1° in the primary repair group across all measured flexion angles (p<.001). The native ACL's mechanoreceptors — the sensors that tell the brain where the knee is — are preserved with repair. A graft cannot replicate them.
Ciceklidag et al., Am J Sports Med 2024 • PMID 38557260
6×
higher rate of post-traumatic OA with reconstruction vs. ACL repair at 6 years
FDA-cleared label claim based on pooled 6-year data from the BEAR I & II studies: a ∓27.7% absolute reduction in radiographically confirmed PTOA for repair vs. reconstruction (p=0.002). PTOA rates as high as 50% have been observed in reconstruction patients. There is no cure other than total knee replacement.
Miach Orthopaedics FDA 510(k) label clearance, January 2026 · BEAR I & II studies
30%
quad strength deficit from arthrogenic inhibition — on top of donor site morbidity
Tunnel drilling triggers quad shutdown. Graft harvest sacrifices healthy tissue. And the proprioceptive nerve endings native to the ACL — the ones that sense joint position — are gone. Grafts rarely reinnervate. Repair keeps the wiring intact.
Rice & McNair, Sports Med 2010 · Lepley, JOSPT 2015 · Fremerey et al., KSSTA 2000
75–90 min
average ACL reconstruction procedure time — at ~$100/min
At ~$100/min in fully-loaded OR costs, a standard recon represents $7,500–$9,000 in OR time alone. Simpler repair recovers those minutes — and with repair-first approaches showing a 6× lower rate of PTOA vs. reconstruction at 6 years (BEAR I & II, FDA-cleared claim, 2026), the long-term cost burden shifts too.
Published surgical series · Stey et al. 2015 · Childers & Maggard-Gibbons, JAMA 2018

Reconstruction replaces a ligament with foreign tissue and accepts the consequences. Repair preserves the Native ACL, its biology, its nerve supply, and the patient's own tissue — and avoids harvesting something healthy to fix something torn. Native was built to make repair the obvious choice.

THE PROBLEM WE SOLVED

The fork in the road surgeons faced.

Until now, ACL repair demanded a compromise: static systems were simple but lacked control; adjustable systems offered control but became overly complex. Native refused that tradeoff.

BEFORE - STATIC REPAIR

Lock it once. Live with it.

Manual. Cancellous. Not retensionable.

  • Surgeon must manually maintain tension throughout

  • Manual fixation with no confirmation of set tension

  • No retensioning capability post-fixation

  • Tissue creep goes unaddressed

NOW - NATIVE FLYTECH™

Optimize until it's right.

Dynamic. Retensionable. Elegantly simple.

  • Dragonfly™ fixes automatically and maintains tension

  • Independent bundle control per construct

  • Re-tension at any time, at your fingertips

  • Zerofly™ provides cortical fixation, with a leave no trace philosophy

PRODUCT PORTFOLIO

Three systems, one platform.

Powered by Dragonfly™ and Zerofly™, our technology has been designed to  perform across the spectrum of primary ACL repair strategies.

Dragonfly Zero — Tibial Eminence Repair — Card
Tibial Eminence Repair
Dragonfly Zero
Faster - multiple fixation vectors.
  • Multiple points of fixation for controlled reduction
  • Dragonflies reduced individually or simultaneously
  • Powered by quad-core finger trap retensionable construct
  • Zerofly™ fixation eliminates metal hardware from fracture site
Dragonfly Zero — Tibial Eminence Repair — Box
% Fewer Steps*
55
Fixation Points
Multiple
Reduction
Individual / Simultaneous
Metal-Free
Yes

*compared to leading adjustable system

Native ACL Prime — Primary ACL Repair — Card
Primary ACL Repair
Native ACL Prime
Fast - belt & suspensors.
  • Cortical Primary repair with supplemental distribution bridge for joint stability
  • Quad-core finger trap with dynamic tensioning: tissue creep management
  • Retensionable repair construct and retensionable bridge
  • Independent bundle tensioning per construct
  • ø4.0mm femoral tunnel – minimizing notch disruption
  • 19-step procedure with full surgeon control at every phase
Native ACL Prime — Primary ACL Repair — Box
% Fewer Steps*
42.4
Retensionable Bridge
Yes
Tunnel Size
ø4.0mm
Distribution Bridge
Joint Stability

*compared to leading adjustable system

Native ACL Prime Zero — New Most Minimal — Card
New — Most Minimal
Native ACL Prime Zero
Fastest - 6 steps - that's it.
  • 2 Dragonfly™ constructs stitched directly to the torn ACL tissue
  • Shuttled through a single ø2.4mm femoral tunnel - smallest available
  • Zerofly™ textile fixation pre-assembled; deploys automatically
  • Conforms to bony anatomy; zero metal implants left behind
  • Independent bundle tensioning with retensioning capability
  • Completes in just 6 procedure steps
Native ACL Prime Zero — New Most Minimal — Box
Steps
6
Tunnel Size
ø2.4mm
Metal-Free
Yes
Retensionable
Yes

CORE TECHNOLOGY

FlyTech™ Platform

Two breakthrough technologies. One unified platform. Powering every Native ACL solution.

Native Tech 4-Block
01
Dragonfly™
Same familiar technique, new indication
Advanced finger trap technology with quad-core architecture delivers dynamic tensioning capabilities that automatically fix and maintain tension. Tension, lock, and retension — without the surgeon manually holding tension throughout.
Dynamic Tensioning Auto-fix Retensionable Independent Bundle Control
02
Zerofly™
Advanced textile cortical fixation
Pre-assembled to the Dragonfly™ construct, Zerofly™ textile fixation deploys through a minimal ø2.4mm femoral tunnel. Once deployed, it is designed to conform to native bony anatomy — leaving absolutely no metal hardware behind.
Metal-Free Cortical Fixation ø2.4mm Tunnel Pre-assembled Designed for the Anatomy
03
Notch-First Philosophy
Minimal footprint fixation
Anchors placed in the intercondylar notch are fixed in cancellous bone — the softer trabecular bone of the femoral condyle. Hardware crowds the notch, blocks visual access, and compromises the repair environment. Native eliminates all of this.
No Notch Crowding Cortical Fixation Clear Visual Field Revision-friendly
04
Surgical Efficiency
Designed by a surgeon, for surgeons
Every element of the Native ACL Prime system has been painstakingly designed to remove as many points of friction as humanly possible, with a goal to deliver an OR experience and surgical result that brings the excitement back to sports medicine.
Insanely Simple Implants Precision-engineered Instrumentation Surgeon-centered Technique

SYSTEM COMPARISON

How Native stacks up against the competition.

Data from published surgical technique guides. Native delivers the most complete combination of simplicity, control, and biological preservation.

Attribute Native ACL Prime Zero Leading Static System Native ACL Prime Leading Adjustable System
Number of steps* 6 steps 11 steps 19 steps 33 steps
Notch crowding 1 ø2.4mm tunnel 2× ø4.75mm anchors 1 ø4.0mm tunnel 1 ø4.0mm tunnel
Retensionable repair YES NO YES YES
Retensionable bridge NO NO YES NO
Independent bundle tensioning YES NO YES NO
Metal-free YES YES NO NO

*Steps recorded using published surgical technique guides

Static systems never delivered the tensioning I wanted, and once locked in, you were stuck. Other technologies tried to solve this but became overly complex - forcing surgeons to choose between simplicity and control. At Native, we refused that tradeoff. We delivered dynamic tensioning, and made it insanely simple.

DR. CHRISTIAN ANDERSON - FOUNDING SURGEON, NATIVE ORTHOPAEDICS

WHY IT MATTERS

The clinical and economic case for Native.

6x simpler than leading adjustable systems

ACL Prime Zero completes in 6 steps vs. 33 steps for leading adjustable competitors — dramatically reducing OR time and cognitive load.

0 metal hardware remaining

Zerofly™ textile fixation delivers clean, hardware-free post-op x-rays and eliminates hardware removal procedures and MRI artifacts.

$62/min: the true cost of OR time

OR time costs hospitals $62-$100 per minute (Shippert, Am J Med Qual 2005). A faster, simpler repair means real savings per case - and emerging repair-first data suggests lower downstream OA burden, avoiding far costlier long-term interventions.

Retensioning capability

Dynamic tensioning addresses tissue creep post-fixation. Surgeons can retension at any time — with full independent bundle control.

FOUNDER INTERVIEW

The full conversation with Dr. Anderson.

The Dragonfly™ was designed from firsthand experience in the OR. Hear directly from the founding surgeon on the clinical problem, the invention, and what comes next.

Interview with Dr. Christian Anderson - Founding Surgeon, Native Orthopaedics

Topics covered:
- Why we do what we do
- How we do what others can't or won't
- What that means for surgeons & their patients