Exploring the ACL Cross Bracing Protocol: A Non-Surgical Approach to Recovery
If you've experienced an Anterior Cruciate Ligament (ACL) rupture, chances are, you’re probably feeling overwhelmed by the prospects of surgery and rehabilitation. Traditionally, the answer has often been reconstructive surgery but thanks to an innovative new approach—the ACL Cross Bracing Protocol—there’s now a non-surgical option that’s offering real hope for healing and recovery.
In this blog, we will explore the ACL Cross Bracing Protocol, a revolutionary approach that is helping athletes facilitate the healing of their ACL injuries.
What is the Role of the ACL?
The ACL plays a crucial role in stabilising your knee joint. It is one of the primary ligaments that helps maintain the proper alignment and function of the knee, allowing for smooth movement during various activities. ACL injuries often occur during dynamic sports that involve sudden movements, such as twisting, rapid changes in direction, or jumping—common in sports like netball, basketball, rugby, and football.
When the ACL is torn, it can lead to a range of symptoms, including intense pain, swelling, and a feeling of instability in the knee. This injury not only impacts your ability to participate in sports and physical activities but can also hinder daily tasks, making it essential to understand the importance of the ACL and explore available treatment options.
What is the Cross Bracing Protocol?
The ACL Cross Bracing Protocol is a non-surgical bracing program designed to heal a complete ACL tear (rupture, full-thickness tear) by bracing the knee in a specific position for an extended period. Created by orthopaedic surgeon Dr. Merv Cross OAM and Dr. Tom Cross, this protocol helps the torn ends of the ACL come together, increasing the chance of healing naturally—no surgery required!
How Does the Cross Bracing Protocol Work?
The Cross Bracing Protocol is a 12-week bracing program that needs to start within 4 weeks of the ACL injury (ideally in the first 10 days post injury). The timeline is broken down into phases that progressively restore movement and function:
Weeks 1-4: The knee is locked at a 90° angle, non-weight-bearing, with the help of crutches or a mobility scooter.
Week 5: The brace allows movement between 90° and 60°.
Week 6: Flexion range opens further from 90° to 45°.
Weeks 7-8: Partial weight-bearing begins. In Week 7, the brace allows full flexion down to 30°, and in Week 8, it opens from 20°.
Weeks 9-12: Full weight-bearing begins, with increased flexion range until Week 12, where the brace is removed, and rehabilitation continues with a full range of motion.
Supervised physiotherapy rehabilitation exercises, focusing on both the injured and non-injured limbs, are crucial throughout the bracing period. As with any treatment, a specific and supervised exercise plan is essential to achieve the best outcome.
What to Expect
The Cross Bracing Protocol offers exciting potential, but its effectiveness depends on several factors, such as the severity and type of ACL injury, any accompanying meniscal damage, overall knee stability, and your personal recovery goals. To determine if it’s the right approach for you, an MRI and consultation with a sports medicine physician or orthopeadic specialist are essential to tailor the treatment plan to your unique situation.
The Benefits
A recent publication (Filbay et al., 2023) has shown exciting results: 90% of participants showed evidence of healing on MRI at 3 months post-injury, and up to 79% returned to pre-injury sport within 12 months.
Avoid surgery: This non-invasive option could help you sidestep surgery altogether.
Reduced symptoms from other injuries: Many participants with associated meniscus tears (49%) found their symptoms became asymptomatic over time.
Key Considerations
Risk of DVT (Deep Vein Thrombosis): Prolonged immobilisation can increase the risk of DVT but this can be managed with prescribed blood thinners and exercises like ankle pumps, quad and hamstring co-contractions, as well as hip abduction and extension movements (Filbay et al., 2023).
Practicality: Everyday activities like showering, sleeping, and getting in and out of the car can be more challenging while wearing the brace 24/7.
Discomfort from the brace: Wearing a brace for 12 weeks may cause discomfort or stiffness.
Risk of Muscle Loss and Knee Contracture: Maintaining knee flexion for an extended period can lead to muscle atrophy and contracture (Perlstein, 2023).
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How to Know if the Cross Bracing Protocol is Right for You?
While the Cross Bracing Protocol offers promising results, its suitability depends on several factors, including the severity of the ACL injury, any associated meniscal damage, overall knee stability, and your individual goals. A comprehensive consultation with a sports medicine physician or orthopeadic specialist, along with an MRI, is crucial to create a personalised treatment plan that fits your specific needs.
Can You Heal Without the Cross Bracing Protocol?
Yes! Even with no bracing, studies have shown that over one-third of ACL injuries can heal with rehab alone (Filbay et al., 2023). However, it's important to remember that healing is not guaranteed with any approach, and results can vary based on the individual and the specifics of the injury.
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How Physiotherapy Can Help
The Cross Bracing Protocol is paired with physiotherapist-guided rehabilitation focused on improving lower limb neuromuscular control, muscle strength, power, and functional training to help you return to sports and recreational activities.
At Kaylana Wellness Collective, we collaborate with sports doctors and physiotherapists to provide top-tier ACL injury treatment. Our structured rehabilitation program follows the Cross Bracing Protocol guidelines, ensuring each milestone is met safely. We tailor a personalised program based on your goals, guiding you through every step of your recovery journey back to the activities you love.
Is the Cross Bracing Protocol the Future of ACL Healing?
The ACL Cross Bracing Protocol offers an exciting and effective alternative to surgery, especially for those hoping to avoid an invasive procedure and still regain full function. The benefits and patient outcomes based on the early research of the CBP are currently very positive (Perlstein, 2023). With high rates of healing, a great chance to return to sport, and fewer complications compared to surgery, it’s no wonder this protocol is gaining attention. However, it’s important to remember that success isn’t guaranteed—like with any injury, individualised care and rehabilitation are key. The Cross Bracing Protocol requires commitment, including sticking to wearing the brace and supervised exercise program during and after the bracing period, to ensure the best chance of success.
At Kaylana Wellness Collective, we endeavour to keep people moving and feeling confident with movement. If you're looking for a personalised physiotherapy plan for your ACL recovery, schedule a free discovery call with our physiotherapist today.
Disclaimer: This blog post is for educational purposes only and is not a substitute for professional medical advice or treatment. Always consult a healthcare professional for personalised care.
References
Filbay, S. R., Rooney, J., & Cross, T. (2023). The Cross Bracing Protocol - A Novel Non-surgical Intervention to Facilitate ACL Healing. ASPETAR Sports Medicine Journal, 12.
Filbay, S. R., Dowsett, M., Chaker Jomaa, M., Rooney, J., Sabharwal, R., Lucas, P., Van Den Heever, A., Kazaglis, J., Merlino, J., Moran, M., Allwright, M., Kuah, D. E. K., Durie, R., Roger, G., Cross, M., & Cross, T.. (2023). Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. British Journal of Sports Medicine, 57(23), 1490–1497. https://doi.org/10.1136/bjsports-2023-106931
Perlstein, K. (2023, July 25). Cross Bracing ACL Rehabilitation Protocol: Our Take. Orthotics plus Melbourne. https://orthoticsplus.com.au/articles/cross-bracing-acl-rehabilitation-protocol-our-take/#:~:text=The%20Cross%20Bracing%20Protocol%20involves%20immobilising%20the%20le