Recommended Physiotherapist Approach to Acute ACL Injury.
These recommendations below are based on the possible adoption of 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.
