I’ve ruptured my ACL! Do I need to get surgery?

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Previously rupturing your ACL pretty much guaranteed you’d get surgery if you ever wanted to play sport or be active again. We used to think ACLs don’t heal – that surgical fixes were the only option.

However, some interesting studies now demonstrate that surgery is not your only option when it comes to ACL ruptures. In fact a bracing protocol and physio alone have been shown to be just as effective as surgery.

What do we know about ACL tears?

Some ACL ruptures can actually heal with a non-surgical approach which was shown on a MRI follow up even after 2 years after injury. Those who demonstrated ACL healing after 2 years, reported better knee function and quality of life compared to those who did not show healing of their ACL. ACL ruptures can be a burden on quality of life, everyday activities and predispose you to early onset osteoarthritis.   

Cross bracing protocol:

Aim is to reduce the distance between the remaining ligament by immobilising the knee at 90 degrees for 4 weeks after rupture in order to facilitate bridging of the tissue and healing of the remaining ACL ligament 

After 4 weeks, weekly increase in knee range of motion + supervised physiotherapy program targeting lower limb neuromuscular control, muscle strength and power, and functional training to return to sport and recreational activities

Table from Physio Network

What to expect with Cross Bracing Protocol:

The first step is to keep the knee fixed in a brace at 90 degrees for the first 4 weeks – 24/7 (including sleeping and showering). Crutches are used in the first 8 weeks (plus other mobility aids if required such as knee scooter, or wheelchair). 

What do our physiotherapists provide with the Cross Bracing Protocol?

  • Fit injured knee in a brace ASAP at 90 degrees knee flexion
  • Advice and education around self-care
  • DVT prevention strategies
  • After 4 weeks, range of motion is adjusted
  • Week 10, unrestricted range of motion is allowed
  • Week 12, remove brace
  • Adjust the brace and progress exercise based program

After 3 months, studies have shown that 90% of participants have demonstrated complete healing of the ACL on MRI findings using the Cross Bracing Protocol. 

What does this mean for you?

In conjunction with physiotherapy and the Cross Bracing Protocol, it is possible that this may be another way to for a non-surgical approach of your ACL rupture. There are lots of factors to consider when deciding on surgery or not for ACL ruptures. The best thing you can do is understand the options and make a decision that sits best for you and your goals.

Link to the journal article 

https://bjsm.bmj.com/content/bjsports/early/2023/06/13/bjsports-2023-106931.full.pdf

The cross brace protocol

https://bjsm.bmj.com/content/bjsports/suppl/2023/06/14/bjsports-2023-106931.DC1/bjsports-2023-106931supp001_data_supplement.pdf

By Chantel Pal

 

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