Exciting research continues to develop surrounding the possibility of natural healing of Anterior Cruciate Ligament (ACL) ruptures and the potential superior outcomes of natural healing over non healed and surgically repaired ACLs. While much more research needs to be done to look at re rupture rates between naturally healed and surgically repaired ACLs, initial evidence suggests significant improvements in patient satisfaction with pain, function and return to sport for healed ACLs as demonstrated in the table below.
From this research, the obvious next question to arise was what can we do to facilitate natural healing of ACLs after rupture? Dr Tom Cross an eminent sports physician and son of famous knee surgeon, Dr Merv Cross theorised that one of the missing pieces of the puzzle was immobilising the knee in a position, which bought the two torn ends of the ACL together. Further research has led to development of the “Cross Bracing Protocol”.
The protocol, essentially immobilises the knee in a brace, flexed to 90 degrees for 4 weeks and then gradually over the course of another 6 weeks, the range of the knee is gradually increased. Throughout this period, the client undertakes regular physiotherapy, aimed at maintaining as much mobility and muscle bulk in the injured leg. The broad outline of the bracing protocol is outlined below.
A study currently under review, has followed the first 80 patients to undertake this bracing protocol and the initial findings appear very exciting, with 90% of clients showing signs of anatomical healing at 3 month MRI follow up. While more work obviously needs to be done to work on grading the degree of healing and following these patients to see how much healing is required to perform as well or better than surgically reconstructed ACLs, the initial findings are very exciting and raise many more questions about what other interventions may increase the degree of natural healing when undertaking the bracing protocol! The full study should be release later this year.
Article by Jim Burke
