Cross Bracing Protocol for ACL injuries in Sydney

Sustaining an ACL injury can be daunting, and navigating treatment options can be overwhelming. The debate between opting for surgery or conservative treatment has been ongoing, with recent evidence challenging traditional perspectives and showcasing promising results with conservative approaches.

Contrary to previous beliefs about limited healing capacity, anatomical studies have revealed that the ACL possesses a rich blood supply. One notable innovation in conservative treatment is the ‘Cross Bracing Protocol,’ pioneered by Dr. Tom Cross. This protocol aims to promote ACL healing by minimizing the distance between the torn ligament and its intended attachment point.

The key principle involves immobilizing the knee at 90 degrees for the initial 4 weeks following an acute ACL rupture. This strategic positioning, ideally between 90-135 degrees of knee flexion, seeks to facilitate tissue bridging and healing within the ruptured ACL remnants.

In Sydney, our specialized physiotherapy services are tailored to implement cutting-edge techniques like the ‘Cross Bracing Protocol.’ Our goal is to guide you through a comprehensive rehabilitation journey, exploring innovative approaches to optimize ACL recovery.

Is Cross Bracing for you?

  • Patients of all ages
  • Must be within 1 month of acute ACL rupture - confirmed on MRI
  • Must be functionally independent and capable of managing a period of knee immobilization
  • Must not have evidence of structural concomitant injuries that need surgical intervention (eg. unstable bucket-handle meniscal tear)
  • Must not have Deep Vein Thrombosis or Pulmonary Embolism

Protocol summary

  • Braced at 90deg for 4 weeks after 4 weeks, knee range-of-motion is increased at weekly increments and progressively
  • NWB with crutches (0-6 weeks), PWB with crutches (7-9), WB as tolerated, wean crutches (10 weeks)
  • MRI at 13 weeks to check healing of ACL
  • Removal of brace at 13 weeks - however is still worn in high risk environments from weeks 13-16
  • Introduction to running at 16 weeks
  • Introduction to change of direction at 18 weeks
  • Introduction to hopping
  • Consider return to training at 20 weeks if meeting criteria
  • Return to play at 26 weeks + (6.5 months +)

The Cross Bracing Protocol requires input from multi disciplinary team including physios, and specialists. If you are in Sydney, reach out to us to see if this ACL treatment path is the right fit for you.