The healing ACL! A Non-Surgical Approach with the Cross Bracing Protocol

When it comes to managing ACL ruptures, historically the ACL has limited ability to heal on its own. However, recent evidence suggests that conservative management could be a viable option for some patients. FIlbay et al. (2023) explores the use of the novel Cross Bracing Protocol (CBP) as a non-surgical approach to managing ACL injuries.

The CBP involves immobilizing the knee at a 90-degree flexion for four weeks immediately after the injury, followed by a gradual progression to full range of motion over the next 10 weeks. The goal of this protocol is to facilitate healing of the ACL by reducing the gap between the two ends of the ruptured ligament and providing it an opportunity to rebuild its continuity.

The study recruited 80 patients with acute ACL ruptures, with an average age of 26, who chose to participate in the CBP after being informed of all treatment options. The use of cryotherapy and anti-inflammatory medications was discouraged to avoid impairing the acute inflammatory response. Additionally, some patients underwent a platelet-rich plasma (PRP) injection to encourage healing.

At the three-month follow-up, 90% of the participants showed MRI evidence of healing, with varying degrees of ACL healing observed. Participants with grade 1 healing reported better outcomes, reduced knee laxity, and a better return to sport compared to those with grades 2-3 healing. However, 14% of participants experienced re-injury, highlighting the need for careful monitoring and follow-up.

While the study had some limitations, such as a lack of control group and departures from the protocol, it provides valuable insights into the potential of non-surgical management for ACL ruptures. Further research is needed to refine the CBP and improve outcomes for patients with ACL injuries.

The CBP offers a promising non-surgical approach to managing ACL ruptures, with encouraging results in terms of ACL healing and patient outcomes. We have found in the clinic, the patients are showing healing ACLs on MRI at week 12 and 24, with good function and strength with clinical testing. However, it is difficult to distinguish the rate of reinjury or function without a longer follow up of patients.

References:

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.

Rodriguez, K., Soni, M., Joshi, P. K., Patel, S. C., Shreya, D., Zamora, D. I., ... & Sange, I. (2021). Anterior cruciate ligament injury: conservative versus surgical treatment. Cureus, 13(12).

Willsey, T. (2023, August, Issue 69). Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Physio Network.