Before you brace after an ACL injury

To avoid complications from bracing, including reducing the risk of blood clots, please read the following.

Bracing with the Cross Bracing Protocol

This information is not a substitute for advice from your doctor, nor does it contain all the relevant facts. Your doctor will consider your personal circumstances. Please talk with your doctor about any concerns.

  • Immediately following a significant knee injury, the extent of the injuries to the injured knee is unknown despite expert clinical evaluation with history, possibly witnessing the mechanism of injury and knee examination pitch side.
  • Until all injuries are accurately ascertained by an appropriately detailed MRI, the knee should it is recommended ideally be treated as having had an ACL rupture. In the acute phase, that is the first 3-5 days at least, a range of motion knee brace set to 30-90 degrees is recommended 24-hours a day and keeping the patient non-weight-bearing on crutches is also recommended. This is to avoid further disruption of an injured ACL, disruption which may possibly reduce the likelihood of a successful healing of the ligament.
  • For similar reasons, examination of the knee should not be done more than once and ideally should be done by the most experienced practitioner and should be gentle. A pivot shift test is not recommended in the acute setting.
  • Anti-coagulation medications should be withheld in the acute phase (days 0-5) to avoid excessive swelling and bleeding from the knee injuries sustained.
  • Prolonged travel, for example a long plane flight or car trip, significantly increases the risk of a DVT in the acute phase and the patient should be managed accordingly to mitigate the risk of DVT before this travel and it is mandatory to perform a clinical and Ultrasound Doppler assessment to rule out DVT once the injured patient has returned home.
  • A thorough medical consultation by a doctor with great expertise in all surgical and non-surgical management options for acute ACL injury should occur soon after the MRI. In a shared decision-making consultation, the patient then is informed on all the knee injuries they have sustained. If they have an acute ACL injury and are considered an appropriate candidate for the Cross Barcing Protocol the Doctor, then discusses the pros and cons of the novel CBP in addition to all other non-surgical and surgical treatment options and the patient decides (parents for children).
  • If the CBP is adopted adults will need to be anticoagulated immediately with Rivaroxaban 10mg at night every night until the patient is weight bearing without crutches.


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