A long-held belief among researchers and clinicians is that a torn anterior cruciate ligament (ACL) has limited healing capacity. This belief has shaped current management strategies for ACL injury rehabilitation, where surgery is most commonly recommended. This method was thought for a long time to be the only treatment choice to manage ACL injuries.
There are now several well-known treatment options for ACL injury. These include ACL surgery or conservative ACL management under a Sports Physiotherapist. Conservative management of ACL typically involves reducing pain and swelling and then progressively strengthening your knee to regain function.
New research has shown that the ACL does have some capacity to heal. A large study previously observed MRI evidence of ACL healing at a 2-year follow-up. Healing occurred in 30% of participants who were randomised to initial rehabilitation and optional delayed ACL reconstruction (1).
But now there is a new tool to conservatively manage ACL injury without surgery. And it has seen even more success – the Cross Bracing Protocol for ACL injuries.
The Cross-Bracing Protocol for ACL Injury
A recent study from Australian researchers sought to investigate whether or not the cross-bracing protocol increased the rate of ACL healing.
The researchers used MRI to look at ACL healing and patient-reported outcomes on how good their knee felt. And they examined knee laxity with a special device. The people involved had an acute ACL rupture managed non-surgically with the Cross Bracing Protocol (2).
This study took eighty patients within 4 weeks of complete ACL injury. All patients were managed with a bracing protocol where the knee was locked in a brace at 90° flexion in brace for 4 weeks, followed by progressive increases in range-of-motion until brace removal at 12 weeks. Following the bracing protocol, patients then had physiotherapy for ACL rehabilitation.
The patients involved did have to meet some particular criteria as below;
- Age 26 (+- 10 years) at the time of injury
- 39% Female
- 49% also had a meniscal injury.
After management of an acute ACL injury with this Cross Bracing Protocol, 90% of patients had evidence of healing on MRI after 3 months (seen as come continuity of the ACL).
Also, greater ACL healing on this 3-month MRI was associated with better outcomes with patients also reporting that their knee functioned better during rehabilitation.
After following the Cross Bracing Protocl, 90% of patients had evidence of their ACL healing on an MRI after 3 months.
Can I brace to heal my ACL Injury?
It is important to note that this is a new area of research and that more long-term information is needed to know what is the best strategy to manage an ACL injury.
Even within this study, the researchers note that 11 patients of the 80 (14%) had re-ruptured their ACL at the time of follow-up. The rate of re-injury observed in this study may be comparable with re-injury rates following ACL repair surgery, whereby approximately 1-in-5 young athletes suffer a rupture of the ACL graft or contralateral ACL, and around 90% of these injuries occur after return to high-risk cutting/change of direction sports (1).
If you have suffered an ACL injury and need to start your own ACL rehabilitation, make sure you see our Physiotherapy and ACL rehabilitation team to start your personalised program. If you wish to try this Cross Bracing protocol to heal your ACL, our team can assist with ACL bracing and your rehabilitation.
(1) Filbay, S. R., Roemer, F. W., Lohmander, L. S., Turkiewicz, A., Roos, E. M., Frobell, R., & Englund, M. (2023). Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial. British journal of sports medicine, 57(2), 91-98.
(2) Filbay, S. R., Dowsett, M., Jomaa, M. C., Rooney, J., Sabharwal, R., Lucas, P., … & Cross, T. (2023). Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. British Journal of Sports Medicine.