ACL Cross Bracing (Healing)
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.
Previously it was believed due to treatment pathways the ACL could not heal. The ACL has a rich blood supply, histolgical studies have shown the ACL to heal at a slower rate than the MCL. An absense in bridging between the ligament remments has been observed which may inhibit healing. The distance betwene ACL origin and insertion is shortest from 90-135 degrees. The aim of the bracing protocol is to facilitate bridging of tissue, whilst maintaining muscle strenghtening.
Prior to committing to the Cross bracing protocol a share decision making process should be under taken with options for early surgery (e.g. associated meniscal injury), rehabilitation with option for delayed surgery (KANON trial) or seeing if you are appropriate for Cross bracing protocol.
Day Of Injury:
RICE
Range of Motion brace set to 30°-90° (or as soon as possible - Ideally - Baufield SecuTech (RRP $750)
NWB on crutches
Arrange for an "emergency" X-ray and MRI, specifically requesting a full sequence / double oblique sequencewith slices no greater than 3mm. Ideally a Victoria House (IMed) for Melbourne based patients.
If in pain, use paracetamol. Avoid anti-inflammatories (NSAIDS) such as Nurofen.
Arrange appointment with myself to discuss the option and fit the brace (we have these onsite in all sizes at Croydon and Prahran for appropraite fitting
Features that determine if the ACL Cross Bracing Protocol is appropriate:
< 21 days post injury to being in brace to get the best heal
When fixing at 90 deg’s locked you will need to be on anti-coagulants (no PBS on this i.e. full price)
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
