ACL Cross Bracing Protocol

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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:

• Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol (Filbay et al, 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.
• 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. 

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:

• 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.
• Anti-coagulant medication to mitigate risk of DVT for the first 60 days

WEEKS 1-4:

• Brace fixed at 90°, 24-hours/day
• NWB on crutches or scooter
• Weekly Physio for exercise progressions from Week 1 -12

WEEK 5:

• Brace 60°-90° NWB
• Can commence swimming in brace

WEEK 6:

• Brace 45°-90° NWB

WEEK 7:

• Brace 30°-140° WBAT
• Can commence stationary bike

WEEK 8:

• Brace 20°-140° FWB

WEEK 9:

• Brace 10°-140° FWB

WEEK 10-12:

• Brace 0°-140° FWB

WEEK 12:

• Out of brace (still bracing for crowds / risky situations)
• MRI to assess ACL healing

WEEK 16:

• Open chain seated leg extensions

WEEK 17:

• Graded running program

WEEK 20:

• Agility

WEEK 26 (6 MONTHS):

• Return to training

WEEK 52 (12 MONTHS):

• RETURN TO PLAY​​