Tag: anterior cruciate ligament

A year ago today, I was told something I thought was impossible — after three months in a knee brace as part of a research program, my previously fully ruptured anterior cruciate ligament (ACL) had healed itself naturally.

I tore my ACL skiing overseas (yes, I became a walking/limping cliche), and once I got home my physio told me about a novel program called the Cross Bracing Protocol.

The ACL runs diagonally through the middle of the knee, connecting the thigh bone to the shin bone, and is crucial to stabilising the joint.

In the last few years, research has proven that ACLs can, in fact, heal on their own, but the bracing protocol takes it one step further.

Just like a cast helps broken bones heal, the brace facilitates the healing of ruptured ACLs that otherwise wouldn’t have healed at all, or might have healed poorly.

Given early results demonstrated 90 per cent of participants’ ACLs healed at the three-month mark, it could revolutionise the way the injury is treated.

And it comes at an important time — Australia has one of the highest rates of ACL reconstructive surgery in the world and the incidence of ruptures is rising, particularly in children and women.

But, like any new medical breakthrough, there are questions about the long-term impact and the veracity of the research.

So, where did this idea come from and how does it work?

Patient number one

In 2014, Tom Cross was treating a colleague’s 19-year-old daughter for an ACL rupture when she raised how desperate she was to avoid surgery, having watched two fellow netballers go through failed reconstructions.

Serendipitously, his orthopaedic surgeon dad, the late Mervyn Cross, was nearby doing his own rehab and suggested they brace her knee instead.

“He pulled the curtain back and said, ‘Back in the 70s, we used to put plaster on people and bend their knee and some of them got better, others didn’t — we never understood it because MRIs didn’t exist,'” Dr Cross says.

“That was patient one and that worked.”

It took another five patients over the next five years, all with successful healing, before Dr Cross decided to offer the novel bracing protocol to every patient who came to him with an ACL rupture.

“I’d sit down for one to two hours with every patient and I made sure I had plenty of time, and I started not charging them because it was [unpublished] research,” he says.

“It was one patient at a time, most people would say, ‘No, I’m not doing this, this is madness.’

“But there were some pioneering patients that said, ‘I’ll give it a go. I’d rather do this first, and surgery second if I need it.'”

Currently, more than 680 patients have felt that way — including myself, patient 293.

How does ACL bracing work?

In a nutshell, the idea is to treat the ACL like an acute fracture — it needs to be treated quickly and the two ends of the ligament, the “stumps”, need to be brought as close together as possible to optimise healing.

Ideally, patients are braced five to 10 days after their injury, with a hard limit of 21 days — I was cutting it fine at day 18.

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Tom and Mervyn Cross’s theory is that in the first few weeks of the brace, the best position to encourage healing is a 90-degree angle.

After that, the range of movement of the knee is slowly increased until it’s straight again.

How long you’re in the brace (six, eight or 12 weeks) depends on the severity of your tear and any other injuries to your knee. I ended up in the brace for 12 weeks, four with my knee locked at 90 degrees and on crutches for eight.

(If that sounds like the end of the world I can tell you it was surprisingly not as hard as I thought it’d be.)

Participants also have to take a blood thinner to reduce the risk of Deep Vein Thrombosis (DVT) while the injured leg is out of action.

You’re also given a week-by-week exercise guide to limit the amount of muscle loss and, once the healing period is over, work on increasing the range of movement.

It’s a nervous wait until the three-month MRI to find out whether it worked, followed by more rehab to build back muscle that’s been lost.

Importantly, it doesn’t mean you can’t have surgery afterwards, or down the line if the healing is unsuccessful or not the quality you need.

What are the results?

Even though almost 700 people have been braced, the first research published on the protocol in June 2023 only looked at the initial 80 participants.

It found that at the 12-week mark, 90 per cent of ACLs had healed.

Dr Cross says that figure has improved slightly, with roughly 94 per cent of participants in the series achieving some kind of heal (more on types of heals in a moment).

So far, patients’ ages range from nine years old to those in their 70s.

In a big step forward for the bracing treatment, researcher Stephanie Filbay and her team at the University of Melbourne have been awarded more than $1.7 million to run a clinical trial comparing patient outcomes and treatment costs between early ACL surgery and the Cross Bracing Protocol.