Can ACLs Heal Without Surgery?
Bracing for ACL Tears: Understanding the Cross Bracing Protocol
Anterior Cruciate Ligament (ACL) injuries are among the most common and debilitating knee injuries, especially for athletes and active individuals. The cost to health systems, insurance companies, indivisuals and elite sporting organisations is very high, let alone the costs in time away from sport, and time to rehab. Proper management post-injury is essential for optimal recovery, and one approach that has gained attention is bracing, including the Cross Bracing Protocol.
In the last six months, I have worked with two clients who used variations of these protocols, and both showed near or fully healed ACLs at 5-6 months post-injury. Their progress highlights the potential of structured bracing and rehabilitation in ACL recovery.
In this blog post, we’ll explore ACL bracing, the benefits of the Cross Bracing Protocol, and how it may contribute to better outcomes post-injury.
Understanding ACL Tears
The ACL is a key ligament in the knee that provides stability and control during movement. ACL injuries often occur due to:
Sudden stops or changes in direction (common in field and court sports, and quite commonly in skiing)
Direct impact to the knee
Poor landing mechanics from jumps
Overextension or twisting of the knee
When the ACL tears, individuals often experience pain, swelling, instability, and reduced mobility. Management options traditionally include surgical reconstruction or in some cases non-surgical rehabilitation, depending on the severity of the injury and the patient’s activity level. A non-sporting, older individual is less likely to go ahead with a surgery and the lengthy recovery costs and time.
What is ACL Bracing?
ACL braces are orthopedic devices designed to support the knee, limit excessive movement, and protect the healing ligament. Bracing can be used in different phases of recovery:
Immediately after injury to provide support and reduce pain
Post-surgery to control motion and protect the graft
During rehabilitation to assist in a gradual return to activity
One innovative approach to ACL rehabilitation is the Cross Bracing Protocol, which aims to optimize healing by restricting knee movement in a controlled manner.
The Cross Bracing Protocol for ACL Tears
What is the Cross Bracing Protocol?
The Cross Bracing Protocol is a rehabilitation strategy that involves keeping the knee in a position of flexion (bent) rather than allowing full extension immediately after injury. The idea behind this protocol is to create an environment that may promote natural healing of the ACL without the immediate need for surgery.
How Does Cross Bracing Work?
The knee is placed in a brace at 90-degree flexion for a set period. Usually between 6-12 weeks.
At 90 degrees, the ACL is under the least amount of stress, compared to other knee positions.
Gradual adjustments are made to allow for controlled movement over time.
The goal is to bring the two broken/torn ends of the ligament close together, which can encourage potential ACL healing while preventing excessive stress on the ligament.
Rehabilitation exercises are introduced progressively to restore strength and stability.
Success Stories: Real-World Application
In the last six months, I’ve had two clients who followed variations of the Cross Bracing Protocol, and both experienced remarkable recoveries:
Client 1: Near full ACL healing at 5 months post-injury. No surgery indicated.
Client 2: Near fully healed ACL at 6 months, avoiding surgery entirely.
These cases align with emerging research suggesting that controlled bracing and rehabilitation may provide an alternative to surgery for select individuals.
Potential Benefits of Cross Bracing for ACL Tears
Supports potential biological healing of the ACL in some cases.
Reduces strain on the knee joint by controlling motion.
Minimizes swelling and pain early in the injury phase.
May delay or eliminate the need for surgery in select individuals.
Negatives of the Bracing Protocols
Bracing in a 90 degree position is a 24hr requirement, meaning showering, driving and mobilising can be very difficult
You will need equipment such as crutches or a knee scooter to get around
You will require anti-coagulant medication to reduce the risk of blood clots
You need to be patient! But no more patient than after an ACL surgery
Is ACL Bracing Right for You?
The decision to use an ACL brace, including the Cross Bracing Protocol, depends on several factors, including:
The severity and location of the ACL tear
Significant associated injuries to the knee including the meniscus and cartilages
The individual’s activity level and goals
Whether surgical or non-surgical treatment is being pursued
Guidance from a sports physiotherapist or orthopedic specialist
ACL bracing is not a one-size-fits-all solution, and a comprehensive rehabilitation plan—including strength training, mobility exercises, and neuromuscular re-education—is essential for long-term knee health.
What to do if You’ve Hurt Your Knee?
Get your knee assessed ASAP! Time is critical and ideally you should be braced within the first few days, and no later than 10 days post-injury. At PhysioPM Townsville, our physiotherapists are trained to assess and diagnose for ACL tears, and can assist in referring for appropriate scans if indicated. We also have a referral network to help you access the best medical specialists in a timely manner.
Final Thoughts
Bracing, including the Cross Bracing Protocol, is an evolving approach in ACL injury management. While research continues to explore its effectiveness, my experience with recent clients suggests it may be a viable alternative for some individuals looking to recover without surgery.
If you’ve sustained a knee injury recently or have a diagnosed ACL injury, seeking expert advice from a physiotherapist or sports medicine professional is crucial in determining the best course of action for your recovery.
📅 Need help with your ACL rehab? Book an appointment today to discuss your treatment options and get on the path to recovery!
