For many years, an ACL rupture was often viewed as an injury that inevitably required reconstruction surgery — particularly for people wanting to return to sport or high levels of activity.

However, our understanding of ACL injuries is evolving.

Emerging research is challenging the idea that a torn ACL cannot heal. Over recent years, exciting new evidence and treatment approaches have raised an important question:

Can some ACL ruptures heal naturally, and how can we support the best possible recovery?

What Does the Latest Research Tell Us?

A landmark 2022 study by Filbay et al. followed people with ACL ruptures who completed a structured rehabilitation program without surgery. Surprisingly, MRI scans showed signs of ACL healing in at least 30% of participants after two years — with these individuals also demonstrating excellent knee stability and function.

This research has changed the way many clinicians think about ACL injuries. Rather than assuming surgery is the only option, we are now exploring which patients may have the potential to heal their ACL and what strategies can improve these outcomes.

One approach gaining attention is the Cross Bracing Protocol (CBP).

What Is the Cross Bracing Protocol?

The Cross Bracing Protocol was developed by Dr Mervyn Cross and Dr Tom Cross as a non-surgical approach designed to support healing following an acute ACL rupture.

The concept is based on positioning the torn ends of the ACL closer together, creating an environment that may encourage the ligament to repair.

How Does the Cross Bracing Protocol Work?

The protocol typically involves approximately 8–12 weeks of structured bracing and rehabilitation.

Weeks 0–4: Protection Phase

• The knee is positioned at approximately 90 degrees of flexion in a specialised brace worn continuously.
• This position aims to bring the torn ACL fibres into closer contact to support healing.

Weeks 4–12: Progressive Rehabilitation

• The brace settings are gradually adjusted to allow increasing movement.
• Physiotherapy begins focusing on restoring strength, movement, knee control, and maintaining overall fitness.

Week 13+: Return to Activity

• A gradual, individualised return-to-work, recreational activity, or sport-specific programme begins.

A 2023 follow-up study by Filbay et al. found that 90% of participants following the Cross Bracing Protocol showed signs of ACL healing on MRI at three months. Importantly, greater evidence of healing at this stage was associated with better longer-term outcomes.

While the brace provides the environment for healing, physiotherapy plays a crucial role throughout the process — helping restore strength, confidence, movement quality, and a safe return to the activities that matter most to you.

Rehab, Surgery, or Bracing: Which Option Is Right?

The reality is that the Cross Bracing Protocol is not suitable for every ACL injury.

Choosing the right treatment pathway depends on a range of factors, including:

• Your age and lifestyle
• Your sport and activity goals
• The timing of your injury
• The type and severity of your ACL tear
• Other associated knee injuries
• Your personal preferences and priorities

Why Might Someone Consider the Cross Bracing Protocol?

Potential benefits may include:

• Avoiding the risks associated with surgery
• Preserving your own native ACL tissue
• Avoiding graft harvesting from another tendon
• Potentially reducing some risks associated with reconstruction
• Keeping surgery as an option in the future if required

However, the protocol also requires commitment, patience, and close monitoring. The initial period of bracing can be challenging, and careful rehabilitation is essential to achieve the best outcome.

Making the Right Decision for You

Every ACL injury is different — and every person has different goals.

The best treatment decisions come from shared decision-making between you, your physiotherapist, your medical team, and your support network.

Together, we consider:

• What you want to return to
• Your work and sporting demands
• Your personal preferences
• The details of your injury
• The current evidence behind each treatment option

Whether your journey involves rehabilitation alone, surgical reconstruction, or the Cross Bracing Protocol, the team at Mountside Physio + Wellness is here to guide you with evidence-based care and support every step of the way.

If you have questions about ACL injury management or would like to discuss your options, get in touch with our team.
�� reception@mountsidephysio.co.nz
314 Maunganui Road, Mount Maunganui

References

• Filbay SR, Dowsett M, Chaker Jomaa M, et al. Healing of acute ACL rupture on MRI after non-surgical management. British Journal of Sports Medicine. 2023;57:1490–1497.
• Filbay SR, Roemer FW, Lohmander LS, et al. Evidence of ACL healing on MRI after rehabilitation alone: secondary analysis from the KANON trial. British Journal of Sports Medicine. 2023;57(2):91–98.
• Cross Bracing Protocol. Home-CBP.