Cross Bracing
Protocol.
ACL healing without surgery. The evidence is changing everything.
The Cross Bracing Protocol (CBP) is an emerging non-surgical treatment for acute ACL ruptures that has shown remarkable rates of ligament healing in early clinical research. We are one of a small number of clinics in Sydney currently offering this protocol.
What is it?
The Cross Bracing Protocol — explained.
The CBP involves placing the knee in approximately 90 degrees of flexion immediately after ACL rupture using a rigid knee brace. This position approximates the torn ACL ends, creating an environment that promotes biological healing of the ligament — something previously thought impossible in adult ACLs.
The protocol was developed and researched by Dr Tom Cross and colleagues in Australia. The early trial results were significant enough to prompt widespread clinical interest globally — and triggered a rethink of the long-held assumption that ACL ruptures invariably require surgical reconstruction.
Important caveat: The Cross Bracing Protocol is still emerging evidence. The initial studies are promising but from relatively small cohorts. Larger randomised controlled trials are underway. We discuss realistic expectations with every patient before commencing the protocol.
Eligibility
Is the Cross Bracing Protocol right for you?
Strict eligibility criteria apply. Not all ACL ruptures are suitable — the protocol works best in a specific subset of injuries.
The protocol
What the Cross Bracing
Protocol involves.
The CBP is a structured 12-week protocol with specific brace angles, rehabilitation milestones, and MRI monitoring at defined intervals.
Brace at 90 Degrees
The knee is braced at 90 degrees of flexion for the first 4 weeks — the position that most closely approximates the torn ACL ends. Weight-bearing as tolerated with crutches. Upper body and unaffected limb exercise continues throughout.
Progressive Extension
The brace angle is progressively opened — typically 10-15 degrees per fortnight — as MRI and clinical assessment confirm healing progress. Weight-bearing increases progressively with brace support.
Full Extension & Weaning
Gradual progression to full extension and then brace weaning. Structured rehabilitation of quad strength, neuromuscular control, and functional movement begins in earnest as the brace comes off.
Rehabilitation to Return to Sport
Same criteria-based strength and return-to-sport rehabilitation as our standard post-operative program. Force plate testing, VALD ForceFrame, sport-specific loading. MRI at 3 months confirms healing status and guides the rest of the program.
Common questions
FAQ — Cross Bracing Protocol.
Is the Cross Bracing Protocol proven?
The early evidence is very promising — the pilot study showed 90% MRI evidence of ACL healing. However, the protocol is still emerging. Larger randomised controlled trials are underway. We're honest about what the current evidence shows and its limitations. For appropriate candidates, the risk profile compares favourably to surgery.
What if the protocol doesn't work?
If MRI at 3 months shows insufficient healing, or if instability persists after completing the protocol, surgical reconstruction remains an option. The CBP does not prevent surgery — it simply attempts healing first. And the rehabilitation you've done during the protocol functions as excellent ACL prehab.
Can I work or study during the protocol?
Desk-based work is typically manageable from week 2-4 onwards. The first 4 weeks with the knee at 90 degrees are the most restrictive. We'll discuss practical modifications for your specific situation at your initial consultation.
How quickly do I need to start?
Immediately. The protocol must commence within 2-3 weeks of injury — ideally sooner. Once the ACL begins to retract and the haematoma resolves (typically by 3-4 weeks), the window for biological healing closes. If you've recently ruptured your ACL and want to explore this option, contact us today.
Does Medicare or private health cover the protocol?
Physiotherapy sessions are covered by private health funds with extras cover. The brace required for the CBP is typically an additional cost. We'll outline all costs clearly at your initial consultation.
Don't wait.
The window closes fast.
The Cross Bracing Protocol must start within 2-3 weeks of injury. If you've recently ruptured your ACL, book a free call today.
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