The ACL Cross Bracing Protocol was developed by orthopaedic surgeon, Merv Cross OAM, and his son, Dr Tom Cross, at The Stadium Clinic in Sydney. The novel concept is to heal a ruptured ACL by bracing the injured knee at 90°, a position that most closely approximates the two ends of the torn ACL. The injured ACL heals, negating the need to replace the ACL with reconstructive surgery.
The Cross Bracing Protocol's first patient to achieve a successful healing of their ruptured ACL was a 19 year old netballer in 2014. A case series of the first 80 patients to follow the protocol was published in June, 2023:
90% of the participants (72 of the initial 80) had signs of ACL healing on 3-month MRI. As of October 2023, there are 487 patients and counting. 284 of the first 301 participants (94%) have achieved ACL healing. There are already more than 100 participants > 2 years post-injury. Currently (only) 11% of ACL Cross Bracing Protocol patients have experienced a re-rupture.
The published protocol is here: ACL Cross Bracing Protocol
Since publishing, the protocol has evolved to include more strengthening exercises at an earlier stage, as well as 6-week, and 8-week variations.
As of October 2023, some key points of the protocol are:
DAY OF INJURY:
Features that determine if the ACL Cross Bracing Protocol is appropriate:
The Cross Bracing Protocol's first patient to achieve a successful healing of their ruptured ACL was a 19 year old netballer in 2014. A case series of the first 80 patients to follow the protocol was published in June, 2023:
90% of the participants (72 of the initial 80) had signs of ACL healing on 3-month MRI. As of October 2023, there are 487 patients and counting. 284 of the first 301 participants (94%) have achieved ACL healing. There are already more than 100 participants > 2 years post-injury. Currently (only) 11% of ACL Cross Bracing Protocol patients have experienced a re-rupture.
- There is a very useful website to help promote the novel concept at healacl.com
- There is a Facebook group of participants at "CBP Bracing Pioneers" Community
- A Patient's Story: The Cross Bracing Protocol
The published protocol is here: ACL Cross Bracing Protocol
Since publishing, the protocol has evolved to include more strengthening exercises at an earlier stage, as well as 6-week, and 8-week variations.
As of October 2023, some key points of the protocol are:
DAY OF INJURY:
- First-aid instructions are here
- Range of Motion brace set to 30°-90°
- NWB on crutches
- Arrange for an "emergency" X-ray and MRI, specifically requesting a full sequence / double oblique sequence
with slices no greater than 3mm. PRP Radiology at The Stadium Clinic reserve emergency MRI slots for ACL ruptures (PH: 8075 3400). - If in pain, use paracetamol. Avoid anti-inflammatories (NSAIDS) such as Nurofen.
- Arrange appointment with Dr Tom Cross to assess the MRI to decide if the Cross Bracing Protocol is appropriate (PH: 8323 6500).
Features that determine if the ACL Cross Bracing Protocol is appropriate:
- 4-7 days post injury
- Gap distance between torn ACL tissue < 4-6mm (depending on patient height)
- No ACL tissue displaced outside the intercondylar notch
- Intact femoral origin of ACL
If the Cross Bracing Protocol is appropriate...
4-7 DAYS POST INJURY:
4-7 DAYS POST INJURY:
- Brace fitting. Dr Cross recommends a Bauerfiend SecuTec Genu Brace with additional 90° extension blocks (that must be specifically requested.) I can supply and fit these braces. Dr Cross has also approved the ASCENDER ROM KNEE BRACE (which I keep in stock and is cheaper).
- Anti-coagulant medication to mitigate risk of DVT for the first 60 days
- Brace fixed at 90°, 24-hours/day
- NWB on crutches or scooter
- Weekly Physio for exercise progressions from Week 1 -12
- Brace 60°-90° NWB
- Can commence swimming in brace
- Brace 45°-90° NWB
- Brace 30°-140° WBAT
- Can commence stationary bike
- Brace 20°-140° FWB
- Brace 10°-140° FWB
- Brace 0°-140° FWB
- Out of brace (still bracing for crowds / risky situations)
- MRI to assess ACL healing
- Open chain seated leg extensions
- Graded running program
- Agility
- Return to training
- RETURN TO PLAY