ACL Cross Bracing Protocol – assessment, brace fitting and ACL rehab in Newcastle

A promising option for recent ACL ruptures

For a long time, many people with ACL ruptures felt they had two main options: ACL reconstruction or standard non-operative rehab.

The Cross Bracing Protocol has added another possible pathway for selected acute ACL ruptures. It is designed to hold the knee in a protected position early, then gradually restore movement, strength and function through a staged rehab process.

We like the protocol because it gives suitable patients another option to explore early after injury. It does not remove the need for careful assessment, MRI review or specialist input, and it does not mean surgery is never needed. But for the right ACL injury, at the right time, it may be a very worthwhile pathway to discuss.

That is why early assessment matters. Cross bracing is only suitable in acute ACL rupture.

What is the Cross Bracing Protocol?

The Cross Bracing Protocol is a structured bracing and rehabilitation pathway for selected acute anterior cruciate ligament, or ACL, ruptures.

The protocol was founded and pioneered by Dr Mervyn Cross and Dr Tom Cross in 2014. It was developed around the idea that some acute ACL ruptures may have the potential to heal when the torn ligament ends are held closer together in a controlled braced position. The protocol involves an early phase of bracing the knee in approximately 90 degrees of flexion to help approximate the injured ACL tissue, allowing for natural healing.

This is different from simply resting the knee and hoping it settles. Cross Bracing is a strict, time-sensitive protocol that involves medical screening, MRI review, brace use, careful monitoring and staged rehabilitation.

It is promising, but it is not a shortcut. The right injury, the right timing, the right brace set-up and the right rehab plan all matter.

Why early assessment matters

Cross Bracing is generally considered for acute ACL injuries, and the official Cross Bracing Protocol material describes an ideal early treatment window to improve healing outcomes. This does not mean every person outside the window is automatically excluded, but it does mean you should not wait several weeks if you want to explore this option.

If you felt a pop, your knee swelled quickly, or your knee feels unstable after football, netball, skiing, basketball, tennis, surfing, gym training or a twisting injury, it is worth being assessed early.

Early assessment can help clarify:

• Whether your injury sounds like an ACL rupture
• Whether MRI or medical review is needed (including organising a prompt and expedited referral)
• Whether the tear pattern may be worth discussing for Cross Bracing
• Whether bracing should be considered
• What you should avoid in the first few days
• What safe early movement or rehab may be appropriate
• Whether surgical opinion may still be needed

The goal is to make a clear decision early, not lose time guessing.

MRI and a sports doctor review is always required to confirm suitability for Cross Bracing. If imaging or specialist review appears appropriate, we can prepare a detailed physiotherapy report and organise a referral via a program called Refr for specialist review and MRI. For suitable patients, this may provide access to Medicare-funded MRI’s and more cost effective specialist referrals without first needing to book a separate GP appointment.

Why Fitness Physio

Fitness Physio can help you move through the Cross Bracing pathway locally in Newcastle. We are experienced in assessing and treating ACL injuries of all types, and have strong local specialist contacts, which allows for prompt referrals to the right people, which is crucial in the time sensitive Cross Bracing Protocol.

We can help with:

• Early and accurate ACL injury assessment
• Fast MRI referral
• Advice on whether Cross Bracing may be worth exploring
• Referral to Dr Tom Cross or Dr Ewen Bradbery to confirm suitability
• Brace fitting and brace education where appropriate
• Early-stage protection, movement and swelling management
• Staged ACL rehab through each phase of the protocol
• Strength and conditioning in our onsite rehab gym
• Return-to-work, return-to-gym and return-to-sport planning

Cross Bracing is not just a brace. It is a full rehab pathway. Our role is to help you understand the process, follow the plan properly, and rebuild the knee step by step.

Could Cross Bracing be suitable for you?

Cross Bracing is most relevant for people with a recent ACL rupture. Suitability depends on the timing of the injury, MRI findings, the type of ACL tear, whether the torn ends are positioned well enough to approximate, associated injuries, and your ability to follow the bracing and rehab process.

It may be worth exploring if:

• Your ACL injury is recent
• You had a clear twisting, pivoting, landing or sporting injury
• Your knee swelled quickly or felt unstable after the incident
• You are looking for a non-surgical option if it is appropriate
• You are willing to follow a strict bracing and rehab protocol
• You can attend the required reviews and rehab appointments
• You want a clear plan rather than waiting and hoping it settles

Cross Bracing is not suitable for every ACL rupture. Some tear patterns, displaced injuries, combined ligament injuries, meniscus/cartilage injuries or unstable knees may be better managed through a different pathway.

At Fitness Physio, we can assess your knee and help decide whether Cross Bracing is worth exploring. If it is, we can refer to Dr Tom Cross or Dr Ewen Bradbery to confirm suitability.

What happens after you book?

Your first appointment is about clarity and timing.

We will ask how the injury happened, what you felt at the time, how quickly the knee swelled, what you have done so far, and what your work, sport or gym goals are. We will assess your swelling, walking, knee movement, strength, control and ligament signs where appropriate. We treat the person, not just the knee.

From there, we will explain what we think may be happening and whether Cross Bracing is worth exploring.

If Cross Bracing may be suitable, we can coordinate and MRI and referral to Dr Tom Cross or Dr Ewen Bradbery for medical review and confirmation. Where the pathway is confirmed, we can assist with brace fitting, brace education and your staged rehab.

If Cross Bracing is not suitable, you will still leave with a clear plan. That may include standard ACL rehab, prehab before surgery, surgical review, or a different bracing and rehabilitation pathway depending on your injury.

What current evidence suggests

Early research into the Cross Bracing Protocol is promising. A 2023 British Journal of Sports Medicine case series investigated MRI evidence of ACL healing, patient-reported outcomes and knee laxity in 80 people managed with the protocol after acute ACL rupture. The study reported that 90% of participants had evidence of ACL healing on 3-month MRI, using the study’s MRI grading criteria.

That is exciting, but it still needs to be explained carefully. Cross Bracing is not a guaranteed way to heal every ACL rupture, and it is not suitable for every injury. Suitability depends on timing, MRI findings, tear pattern, associated injuries, knee stability, goals and the person’s ability to follow the protocol.

There is a larger study on the protocol underway currently called the EMBRACE trial.

Find out more here

The practical takeaway is this: if you have a recent ACL rupture, Cross Bracing may be worth exploring early. The sooner you are assessed, the sooner you can understand whether this pathway, standard ACL rehab or surgical review is the best next step.

Cross Bracing, surgery or standard ACL rehab?

After an ACL rupture, there may be several possible pathways.

Some people may be suitable for Cross Bracing. Some may do well with structured non-operative ACL rehab. Some may need or choose ACL reconstruction, especially with ongoing instability, high pivoting-sport demands, displaced tear patterns or associated injuries.

At Fitness Physio, we will not push one pathway for everyone. We are enthusiastic about Cross Bracing because it is a promising option for selected acute ACL ruptures, and we want more people to know about it early enough to consider it. But the right plan still depends on the injury in front of us.

If surgical review is needed, we can help coordinate referral pathways with local orthopaedic surgeons.

To learn more about the options, check out our general ACL and knee ligament page below that has more information.

Book a Cross Bracing assessment in Newcastle

If you have recently ruptured your ACL, or you suspect you may have, book an assessment at Fitness Physio in Merewether.