Conservative ACL rupture management – A review – Matthew Delaney
A newly published study from Filbay et al (2023) shows promising results with the use of the
cross bracing protocol (CBP) after ACL injury. The aim of the study was to assess MRI
evidence of ACL healing, patient reported outcomes and knee laxity in individuals after ACL
rupture managed with the CBP.
The study included 80 participants of which 72% showed evidence of ACL healing at the 3
month MRI after completing the CBP as well as improved patient reported outcome
measures. Combined with the results of the KANON trial we see that these patients with
ACL healing on scan have better knee function and quality of life than those managed non-
operatively with ACL discontinuity. Further to this the study noted return to sport rates that
are higher that some studies with ACL reconstructed individuals 74% compared to 55% at
the 12 month mark.
It is important to consider that as part of this study individuals were excluded if they had
any concomitant injuries that require surgery (eg: bucket handle meniscus tear) or had a
history of DVT due to the period of immobilisation in the protocol. Of those individuals that
had minor meniscus injuries 98% of them had symptomatic resolution after the bracing
protocol.
The authors did note that though favourable outcomes were shown further research is
needed to investigate whether the characteristics of the ACL rupture observed on MRI is
associated with the likelihood of ACL healing. Factors such as partial or complete femoral
avulsion, the displacement distance of the ACL outside the intercondylar notch and the gap
distance between the ruptured ACL stumps may affect the healing process.
It’s also Important to consider the bracing protocol itself. The has been published along
with the study. The first four weeks of the bracing protocol are non-weight bearing and your
knee is locked in 90° from there the range of motion and weight bearing capacity are
gradually increased over a further eight weeks whereby you are able to take the brace off at
the 13 week mark. Depending on individuals’ lifestyles and ability to adhere to non-weight-
bearing and brace wearing this may affect personal decision-making.
This study shows promising results for ACL healing in appropriate circumstances. The further
research suggested for your study will indicate whether or not this will be applicable in the
long-term for non-operative management of ACL tears.
See below to read the full study
CBP Protocol for ACL rupture
If you need help with your ACL rehabilitation get in contact with us today!
