Cross bracing protocol for anterior cruciate ligament (ACL) rupture has unacceptably high failure rate relative to surgical stabilisation

Key Points

1. In pivoting athletes with acute ACL rupture, the Cross Bracing Protocol resulted in significantly higher rates of recurrent instability (70%) compared to surgical stabilisation (2.5%) at two years.

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BACKGROUND & OBJECTIVE

Interest in nonoperative management of anterior cruciate ligament (ACL) rupture has increased following recent research suggesting MRI evidence of ligament healing using the Cross Bracing Protocol (CBP) (1). Some research in this area has relied heavily on MRI for both diagnosis and grading of healing, however, imaging continuity does not necessarily equate to restored ligament strength or stability. Previous data reported approximately 90% MRI continuity following CBP (1), but longer-term comparative outcome data in pivoting athletes remain limited.

Given the renewed attention surrounding CBP and its proposed capacity for biological healing, this study aimed to compare two-year clinical outcomes between CBP and surgical stabilization in patients with acute ACL rupture.

Interest in nonoperative management of anterior cruciate ligament rupture has increased following recent research suggesting MRI evidence of ligament healing using the Cross Bracing Protocol.

In pivoting athletes with clinically unstable ACL ruptures, surgical stabilization may provide superior mechanical stability and protection against secondary meniscal injury over a two-year period.

METHODS

This prospective controlled cohort study included 80 skeletally mature patients aged 16–40 years with acute, isolated ACL injury confirmed clinically (grade three Lachman and a positive pivot shift) and on MRI. All participants were involved in pivoting sports and intended

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