Recommended Physiotherapist Approach to Acute ACL Injury.

These recommendations below are based on the possible adoption of the “Cross Bracing Protocol”.

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.

  • If the “Cross Bracing Protocol” CBP is being considered a medical consultation at the earliest opportunity is mandatory.
  • The acutely injured patient must be referred to a doctor to evaluate and manage the injury and the risk of adverse events like DVTs or Pulmonary Embolism.
  • A thorough history and gentle examination is recommended early on days 1 or 2 after injury. This involves for testing ACL competency with a gentle Lachman by one examiner. No pivot shift should be performed.
  • Acute Knee MRI examination should involve all sequences plus the “double-oblique” sequence.
  • If the CBP is commenced anti-coagulant medication must be initiated and a doppler ultrasound may be required to exclude DVT.
  • The opportunity for healing the injured ACL is ideally 5-10 days after injury.
  • Bracing the knee 30-90 degrees and NWB is recommended in the first 4 days.
  • Bracing at 90 degrees is not recommended for patients in the first 4 days.
  • The CBP is not recommended after 21 days post-injury.
  • Zimmer splints are not appropriate for ACL injuries.
  • Anti-inflammatories are not recommended.
  • Return to high demand pivoting sports should not be < 12 months (and then only if criteria for RTS met).
  • The ACL-heal CBP research has been recently published in the December 2023 edition of BJSM


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