Cross-Bracing Protocol

The protocol involves wearing a fixed range-of-motion brace, initially locked at 90° flexion, over a typical 8 or 12-week period. The exact time may vary depending on the specific nature of your injury and personal circumstances. The brace is gradually adjusted to allow the knee to straighten progressively. Although in the early stages, you will need to use crutches, your individualised rehabilitation program, created by your team of experts, will commence from the first week. 

During the initial period between the injury and having an MRI scan, you will be recommended to wear a less restrictive brace from 90-30° to optimise the knee’s early healing, without prematurely locking the knee in a fixed position. If your injury doesn’t turn out to be eligible, this brace is still useful to protect the knee in the first weeks of recovery. 

Following the final week of the protocol, you will require a second MRI scan to assess the extent of healing, and to allow your team to make accurate further recommendations on how to proceed with treatment. At this point you may need an appointment with an orthopaedic surgeon, however your team will advise you if that is necessary.

Your Consultant and physiotherapist will determine your eligibility based on the assessment, a thorough history of your circumstances and injury, and MRI findings. Therefore, it is essential to obtain an MRI scan as soon as possible following your injury to assess your suitability for the protocol. Please note, that a specific scan sequence is required for accurate assessment, which is not routinely offered by all providers, so please speak with one of our team before booking one yourself.

The optimal time to brace your knee is between 4-10 days post injury to improve the likelihood of success. However, if your injury is <21 days ago bracing can still be considered. 

It’s important to note that this treatment may not be right for everyone. Certain medical conditions may exclude you from this treatment. For example, due to the extended period of reduced mobility, individuals with a history of blood clots or deep vein thrombosis (DVT) may not be eligible. Other lifestyle factors may also mean this approach isn’t feasible, such as certain occupational or childcare requirements. If you’re unsure, make sure to seek the opinion of a cross-bracing clinician.

Benefits include: 

• Avoids risks associated with surgery and general anaesthesia, such as infection, bleeding, or post-surgical joint stiffness. 

• Aims to preserve native ACL tissue and joint mechanics. 

• No damage to the hamstring or patellar tendons (these tissues are used during  reconstruction surgery to build the ACL graft)

• May enable an earlier start to rehabilitation and a faster return to full function. 

Potential Drawbacks:  

• Restricted mobility for several weeks, including potential increased risk of clotting. 

• You’ll need to wear the brace during sleep and showering, and it may mean you’ll be unable to drive etc. 

• There could be a possible need for future surgical reconstruction if the ACL fails to heal sufficiently throughout the bracing period. 

• As this is a newer form of treatment there is limited long-term data on knee health and re-rupture risk compared with surgery. 

This list is not exhaustive, and all risks/benefits will be discussed with you to help you make an informed decision. You will have the opportunity to ask any questions you may have during your initial consultation.