Management of an acute complete ACL rupture using the Cross Bracing Protocol and progressive rehabilitation in a physically active adult: a case report
Year: 2026
Type: preprint
Study design: Case Report
Abstract: Background: The Cross Bracing Protocol (CBP) is an emerging nonoperative approach for acute anterior cruciate ligament (ACL) rupture, but detailed reporting of its integration with progressive rehabilitation in community-based physiotherapy is limited. Objective: To describe the clinical implementation and outcomes of CBP followed by progressive rehabilitation in a physically active adult not participating in competitive sport. Case: A 41-year-old physically active woman sustained a complete proximal ACL rupture while recreational skiing. After discussion of the options, protocol burden, risks, and uncertainties, she chose CBP partly because magnetic resonance imaging (MRI) morphology was considered potentially suitable; specialist review was planned to guide continuation. Intervention: CBP commenced 16 days after injury and included anticoagulation and staged progression of bracing, weight-bearing, and exercise. The brace was fitted in person; physiotherapy was delivered predominantly by telehealth and progressed to resistance training, running, jumping, hopping and landing. Outcomes: At 12 weeks, MRI showed continuous, full-thickness ACL fibers. Specialist correspondence described the appearance as representing the highest healing category but did not specify the grading system or record a numerical grade; Lachman and pivot-shift tests were negative. At approximately 13 months, estimated knee-extension and hamstring-curl performance was nearly symmetrical, but single-hop and six-meter timed-hop limb-symmetry indices were 86.3% and 81.8%, respectively, and the planned test battery was incomplete. She returned to recreational skiing without reported instability or reinjury, although fear of reinjury reduced her confidence and enjoyment. At approximately 20 months, MRI showed a normal-thickness, taut ACL with the native ACL component assigned an Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS) of 0; Lachman testing and physiological glide were symmetrical between knees. No deep-vein thrombosis or significant bleeding was documented. Conclusion: This case illustrates community-based implementation of CBP and progressive rehabilitation, delivered predominantly by telehealth with specialist involvement. A single case cannot establish effectiveness, safety or generalizability; MRI healing should be interpreted alongside symptoms, clinical stability, function, and activity demands.
Authors: Ford, Geoff R., Meigh, Neil J.
Institution: Bond University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7219709542
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