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Stop! Do not get ACL surgery until you have read this...

Updated: Sep 7, 2023

There’s a new game-changing therapy helping those with a ruptured ACL to heal without going under the knife.


Anterior cruciate ligament (ACL) ruptures are the most common sports-related injuries to the knee, and are one of the most feared injuries - often ending sporting dreams and careers. High profile athletes are often featured in media stories full of fear and dismay as they are rushed into an inevitable surgery before a year long rehabilitation and may not ever return to their sport.


The assumption is that an ACL rupture requires ‘fixing’ with reconstruction surgery, but the outcomes of this surgery are poor. The rationale for surgery is based largely on the belief that ACLs can’t heal.


However, the groundbreaking new research - The Cross Bracing Protocol (CBP) - shows that ACLs can in fact heal, offering hope of better outcomes for some people who rupture their ACL.

The Cross Bracing Protocol (CBP) was developed by Drs Merv and Tom Cross in Sydney, Australia, to aid healing of a ruptured ACL by reducing the gap between the torn ends of the ligament.

What is the Cross Bracing Protocol?

The CBP involves immobilising an injured knee in a brace at 90°for 4 weeks. Then gradually increase the range of motion at the knee with the brace until it is removed at 12 weeks. During this period patients undergo intense physiotherapy based rehabilitation including exercises on the affected leg to reduce muscle and strength losses and aid in promotion of general health.

What is the healing rate of the Cross Bracing Protocol?

The CBP has so far produced a heal rate of 90% with ACL continuity on MRI at 3 months post injury. More healing on a 3-month MRI was associated with better self-reported knee function and knee-related quality of life, higher return to sport rates and reduced knee laxity.

Here at Be Strong Physio in Caloundra, we managed the first ever Cross Bracing Protocol participant on the Sunshine Coast. After working with our patient for 12 weeks, she had a FULL heal of her completely ruptured ACL.

If you want to heal your ACL - act fast!

There is a narrow “window of opportunity” and time is critically important. It is best to get in the brace within a week (possibly up to about 18 days). But early is better as the torn ends of the ACL can seal over, preventing healing from taking place and this varies from individual to individual.


What should you do if you have recently torn your ACL?

Ideally see someone who is currently working with the CBP who can tell whether you need an MRI for a likely ACL rupture. Ideally your Physiotherapist or Physician will be able to fit you in a brace (which may initially not be fixed at 90 degrees yet). It is important not to see someone who is going to perform strong tests on the knee which can further separate the torn ends, possibly impacting your ability to have a successful heal.

Keep your knee bent and do NOT push it straight. If possible use crutches and at least minimise weight bearing until you get your MRI. Avoid taking anti-inflammatories which can impede healing.

Once you get the results of the MRI, your healthcare professional can go through the results with you to see if you are a good candidate for healing. Remember that the decision of CBP v surgery v exercise based rehabilitation is yours. Your healthcare professional should provide you with all the advantages and disadvantages of each based on your presentation so that you can make an informed decision for your long term knee health.

What if you are overseas skiing?

If you are overseas skiing, try and find a Physiotherapist who is experienced with the CBP or contact one remotely via telehealth. Wait for 5 days to fly to reduce your risk of DVT and if possible use anticoagulants, or at least aspirin and take measures to reduce your risk such as wearing compression socks and performing regular ankle exercises on the flight. You should wear a brace that limits knee straightening but still allows the knee to bend.

Then book in to see an experienced Physiotherapist or Sports Physician who works with the CBP so that they can arrange an MRI and if appropriate get you started on the bracing protocol including the exercise based rehabilitation.

Where can I find more information about the CBP?

The initial study from the Cross Bracing Protocol was published in the British Journal of Sports Medicine which is freely available. You can find Geoff on Instagram and his clinic is at Moffat Beach on the Sunshine Coast (www.bestrong.physio)


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