The ACL Cross Bracing Protocol

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FAQ on the ACL Cross Bracing Protocol

1. What is the ACL Cross Bracing Protocol?
The ACL Cross Bracing Protocol is a non-surgical method developed by orthopaedic surgeon Merv Cross OAM and Dr. Tom Cross for healing a ruptured Anterior Cruciate Ligament (ACL). It involves bracing the injured knee at a 90-degree angle, which closely aligns the torn ends of the ACL, facilitating natural healing and potentially avoiding reconstructive surgery.

2. How successful is the ACL Cross Bracing Protocol?
Initial studies show promising results. The protocol has demonstrated a high rate of ACL healing. A published case series revealed that 90% of participants showed signs of ACL healing on MRI scans after 3 months. More recent data from a larger patient pool shows healing in 94% of participants. The re-rupture rate is reported to be around 11%.

3. Who is a good candidate for the ACL Cross Bracing Protocol?
Ideal candidates are typically those who have experienced an acute ACL rupture (4-7 days post-injury) and meet specific criteria. These include a gap distance between the torn ACL tissue of less than 4-6mm (depending on patient height), no ACL tissue displaced outside the intercondylar notch, and an intact femoral origin of the ACL. Assessment by a specialist like Dr. Tom Cross is crucial to determine eligibility.

4. What does the ACL Cross Bracing Protocol involve in the initial weeks following injury?
The protocol starts with first-aid instructions and involves wearing a range of motion brace initially set to 30°-90°, and then fixed at 90° for the first 4 weeks, combined with non-weight bearing (NWB) on crutches or a scooter. Patients also need to use anti-coagulant medication to mitigate risk of DVT for the first 60 days. Weekly physiotherapy sessions are required for exercise progressions, and regular brace adjustments take place.

5. What type of brace is recommended for the ACL Cross Bracing Protocol?
Dr. Cross recommends the Bauerfeind SecuTec Genu Brace with additional 90° extension blocks (specifically requested). The ASCENDER ROM KNEE BRACE is another approved option. The brace must allow for specific range-of-motion limitations as prescribed in the protocol.

6. How does the protocol progress over time?
The protocol involves a gradual progression in brace range of motion, weight-bearing status, and exercises. Starting with a fixed 90-degree brace and non-weight bearing, the brace angle is progressively increased, and weight-bearing is gradually introduced. Swimming and stationary biking can be commenced in the brace. More intense activities like running and agility exercises are introduced later, after several months of rehabilitation.

7. When can a patient expect to return to play after following the ACL Cross Bracing Protocol?
The timeline for return to play is approximately 12 months. This includes a graded progression through strengthening exercises, running programs, and agility drills. Return to training is usually possible around 6 months, with a full return to play at 12 months, contingent on successful healing and functional recovery.

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