Acute ACL Bracing Protocol

What are the Signs of an ACL Injury?

Anterior Cruciate Ligament (ACL) injuries tend to occur with hyperextension or rotational forces on the knee.

Often the player will report immediate pain and need to leave the field. A sensitive sign of an ACL rupture is rapid development of marked swelling in the knee over the course of about the first hour. This is usually due to the bleeding that occurs with the ligament rupture, and is called a haemarthrosis.

A doctor or physiotherapist can use clinical tests to determine the function (or lack thereof) of the anterior cruciate ligament by stressing it gently.

An MRI is recommended for any suspected internal knee problem that leads to marked swelling and pain, and you should see a doctor or your GP immediately if this occurs.

Can I try bracing my ACL injury?

While surgery has been considered the gold-standard management for an ACL rupture, over the past decade, we have seen a few case reports and case series of ACL ruptures healing with rest and or bracing. This has generally resulted in full healing seen on MRI and with clinical tests. It does not automatically mean that patients are able to return to sport with a stable knee and rehabilitation is always required.

Dr Merv Cross and Dr Tom Cross are acknowledged in developing a formalised bracing protocol based on experimental studies of ACL biomechanics, clinical experience and a current trial that is showing promising outcomes. Please contact the Stadium Clinic for further details.

There have even been reports of athletes returning to elite level sport WITHOUT an intact ACL. This is rare, but a testament to the adaptability of the human body and particularly in older athletes with extremely advanced motor skills and coordination. While return to straight line sports can be considered in most people who feel stable during daily activities, the risk of returning to pivotting sports without an intact ACL is that further damage can be done to the other structures in the knee, particularly the meniscus cartilages. This can lead to pain and the requirement for surgery.

Bracing is an option designed to maximise the chance for healing of the ACL, in a position of minimal tension on the ligament. After full medical assessment, it can be trialled in most patients.

What is the ACL Bracing Protocol?

There are various bracing protocols. The protocol with the most recent research validation is called th CBP or "Cross Bracing Protocol".

Contact The Stadium Clinic Sydney, for further information.

What are the Potential Side Effects and Can I Change to Surgical Repair?

At any stage of this process, a patient that was considered appropriate for a bracing protocol can chose to undergo surgical reconstruction of the ACL. The only downsides to bracing are the loss of time, increased stiffness, discomfort of the brace and DVT risk. Having your own, native ACL and avoiding surgery should be considered a better outcome but is not always practical or medically responsible (e.g. unstable meniscal tear with ACL rupture).

Reference List

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