Can ACL Ruptures Heal? Exploring New Options Beyond Surgery
No. The ACL has a poor blood supply, and surgery is the gold standard for returning to sport.
But emerging research is beginning to challenge this long-held belief.
Over the last few years, new evidence and new treatment approaches have opened the door to an exciting question:
Can some ACL ruptures actually heal — and if so, how can we help them do it?
Over the last few years, new evidence and new treatment approaches have opened the door to an exciting question:
Can some ACL ruptures actually heal — and if so, how can we help them do it?
What the Latest Research Says:
A landmark 2022 study by Filbay et al. followed people with ACL ruptures who completed a structured rehabilitation program. Surprisingly, at least 30% showed signs of ACL healing on MRI after two years and also demonstrated excellent knee stability and function.
This finding has shifted thinking worldwide. If the ACL can heal in certain cases, the next step is understanding how to increase the number of successful healing outcomes — and that’s where the Cross Bracing Protocol comes in.
What Is the Cross Bracing Protocol (CBP)?
Developed in 2014 by Dr Mervyn Cross and Dr Tom Cross, the Cross Bracing Protocol offers a non-surgical approach to managing acute ACL ruptures.
How It Works:
The CBP typically spans 8–12 weeks:
1. Weeks 0–4:
○ The knee is immobilised 24/7 at 90° of flexion using a specially adjusted brace.
○ This positioning helps bring the ends of the torn ACL closer together to promote natural healing.
2. Weeks 4–12:
○ The brace is gradually adjusted to allow an increasing range of motion.
○ Rehabilitation exercises begin under physiotherapy supervision, focusing on strength, control, and maintaining general fitness.
3. Weeks 13+:
○ A graduated return to sport-specific program.
A 2023 follow-up study by Filbay et al. found that 90% of patients following the CBP showed signs of ACL healing on MRI at 3 months. Importantly, the more healing seen at 3 months, the better the long-term outcomes.
Alongside bracing, structured physiotherapy remains essential, guiding patients toward a safe return to work, daily activities, and sport.
Rehab vs Surgery vs Bracing: Making the Right Choice.
The reality is that not every ACL injury is suitable for the Cross Bracing Protocol. Choosing the right pathway involves many factors, including:
● Age
● Sport or activity demands
● Timing of injury
● Mobility requirements
● Type and severity of the ACL tear
● Associated injuries
Why Some Patients Consider the CBP
Potential benefits include:
● Avoiding surgical risks
● Avoiding graft harvesting (which uses a healthy tendon)
● Lower cost
● Potentially reduced risk of re-rupture due to preservation of native ligament fibres
● The option to still pursue ACL reconstruction later if needed
However, CBP also requires high commitment, early immobilisation, and careful monitoring — and it isn’t appropriate for every tear.
The Importance of Shared Decision-Making
Every ACL injury is unique, and so is every patient. The best outcomes come from open discussion between you, your physiotherapist, your medical team, and your support network.
Together, you’ll consider:
● Your goals
● Your sport or work demands
● Your personal preferences
● The nature of your injury
● The evidence behind each treatment option
Whether your path includes rehabilitation alone, surgery, or the Cross Bracing Protocol, our team is here to guide and support you at every stage.
If you have any querie's please contact us at reception@buretaphysio.co.nz or give us a call on 075761860
Resources:
- Home-CBP - Cross Bracing Protocol
- Filbay SR, Dowsett M, Chaker Jomaa M, et al. Healing of acute ACL rupture on MRI after non-surgical management. Br J Sports Med. 2023;57:1490–7.
- Filbay SR, Roemer FW, Lohmander LS, et al. Evidence of ACL healing on MRI after rehabilitation alone: secondary analysis from the KANON trial. Br J Sports Med. 2023;57(2):91–8. doi:10.1136/bjsports-2022-105473.
