ACL surgery is one of the most common orthopedic surgeries in the US. Some estimate over 200,000 people a year get this procedure.

While most people have great outcomes (if they do the rehab), some struggle with life long problems.

These problems include: decreased sport participation, early onset of knee osteoarthritis, persistent pain, and impaired long term quality of life.

Luckily, there is new research suggesting the ACL has the capacity to self heal without surgery.

Cross Bracing Protocol

The ACL is slacked/shortened as the knee bends.

This protocol essentially puts the ends of the torn ACL close together by immobilizing the knee at 90 degrees of flexion.

“The CBP consists of 12 weeks of knee bracing coupled with physiotherapist-supervised exercise-based rehabilitation. For the first 4 weeks the knee brace is locked at 90 degrees flexion, followed by weekly adjustments to the brace allowing incremental increases in knee range-of-motion, with unrestricted range-of-motion achieved by week 10. Weight bearing was allowed whilst braced, within the available range-of-motion. Patients were prescribed an anticoagulant for the first 8 weeks to mitigate the risk of deep vein thrombosis (DVT)”

Does it work?

This is a lot of hassle if it doesn't work. Muscle atrophy, joint contractures, cardiovascular wasting, etc.

However study was very positive:

“Evidence of ACL healing on 3-month MRI was observed in 72 out of 80 (90%) patients who were managed with the CBP”

This is quite a powerful result.

Not only does it lead to better outcomes, but with our broken medical model, it can save people a ton of money.

Summary

The big thing to keep in mind is that it's just one study.

This seems to be a new protocol.

There is a risk/reward with this protocol. All of the variables should be taken into consideration.

A question I would have is how soon after the tear do you need to start the protocol?

Maybe if you've just torn your ACL, you should go ahead and brace it at 90 degrees of flexion while you decide what to do.

https://blogs.bmj.com/bjsm/2024/06/14/can-the-novel-cross-bracing-protocol-facilitate-healing-of-acl-rupture/