It is a common belief among practitioners that ACLs cannot heal, and surgery is almost always the first option. However, did you know that ACLs can heal on their own without surgery using The Cross Bracing Protocol (CBP)?
This notion goes against everything that we have been taught and has opened a portal into the world of conservative ACL management. In fact, in the management of acute ACL rupture with the CBP, 90% of patients had evidence of healing on 3-month MRI!
What is the ACL CBP?
The CBP is a structured 24/7 bracing program that manipulates the position of the knee to help reduce the gap distance between the two ends of the ruptured ligament. Studies have shown that the distance between the ACL origin to its insertion is shortest at 90-135 degrees of flexion. Therefore, the knee is immobilised at 90 degrees flexion for 4 weeks to facilitate bridging of tissue between the two ends of the ACL.
After 4 weeks, the range is slowly increased at weekly increments until the knee is fully extended. This is coupled with physiotherapy treatments that target muscle strengthening, flexibility, functional training and neuromuscular control.
| 12 Week Cross Bracing Protocol | |
| WEEK 1- 4 | 90 deg NWB |
| WEEK 5 | 60-90 deg NWB |
| WEEK 6 | 45-90 deg NWB |
| WEEK 7 | 30-120 deg WBAT |
| WEEK 8 | 20 deg ext FWB |
| WEEK 9 | 10 deg ext |
| WEEK 10 | Unrestricted ROM |
Inclusion/Exclusion Criteria
| Eligibility | Absolute Contraindications | Relative Contraindications |
|
|
|
Predictors of good ACL Healing
- Time to brace (ideal is between 4-7 days of injury)
- Gap distance between two ends of the ACL (<4-6mm)
- Non-displaced – no ACL tissue displaced outside the intercondylar notch
- Femoral origin of the ACL is intact
After 12 weeks of the protocol, the patient then conducts another MRI and is given an ACLOAS score. The higher the ACLOAS Score, the less integrity the ACL has.
ACLOAS Score
0 = normal ligament
1= thickened ligament with normal course and continuity
2 = thinned or elongated but continuous ligament
3 = absent ligament or complete discontinuity
A Physiotherapist’s Cross Bracing Testimony
As a physio, the worst injury you could do is an ACL. I was unfortunate enough to fully rupture my R ACL on July 22nd 2024 after a bad fall while bouldering. I opted to do the CBP as I had attended the course in 2023 and wanted to trial conservative treatment.
My MRI showed a full ACL rupture with a rupture zone of 5mm and the tibial stump was flipped slightly forward. Due to the high trauma of the incident, I had also sprained my MCL, LCL, PCL and bruised the lateral compartment. That’s insane right ?! I was however diagnosed and braced early; within 2 days of injury. So, based on these factors, Dr Cross gave me an 80% chance of a good heal. These were odds I was definitely willing to take .
After doing the full 12 week protocol, I found that it was more of a mental than physical challenge. Being immobilised at 90 degrees for 4 weeks was immensely difficult. Not being able to drive, work , sleep comfortably, shower independently and walk took a toll on my mental well being. It is essential to surround yourself with friends and family for social support, and I definitely would not have made it without my mum and sister.
Fast forward 3 months, I had a repeat MRI and received a silver heal! That would be an ACLOAS score of 2, which means my ACL has healed continuously but in an elongated position. I have decided to push on with conservative treatment for another 9 months and make a decision regarding returning to bouldering closer to that date.
If you have done your ACL, I would definitely recommend the bracing protocol if you are looking for a different alternative to surgery. You can also click the link below to read the paper on The Cross Bracing Protocol for more information.
Book an Appointment Now!
If you would like personalised advice or have any questions, feel free to call us at 9736 3950 and ask for Rawan. We’re here to help you on your journey to better health and well-being.
You can also request a call now or book an appointment online through our website. We look forward to hearing from you soon!
Our professional Physiotherapists and Exercise Physiologists can work on a suitable schedule when you book with us via call.
- Precision Physio Concord: 02 9736 3950
- Precision Physio St Marys: 02 9623 2220
- Precision Physio Mt Druitt: 02 9188 2552
A passionate Bulldogs fan and a thrill-seeking boulderer, Rawan brings a unique perspective to our Concord clinic. She’s currently on a journey to heal her ACL injury using a groundbreaking, non-surgical method called the Cross Bracing Protocol. As a physiotherapist herself, Rawan understands firsthand the challenges of recovering from a serious injury. Her personal experience combined with her professional knowledge makes her a valuable asset to our team. Want to see how it’s going? Follow Rawan’s progress and witness the power of conservative ACL treatment!
1 Comment. Leave new
Good.