Cross Bracing Protocol for Anterior Cruciate Ligament (ACL) Rupture Has Unacceptably High Failure Rate Relative to
Mark D Porter1, Bruce Shadbolt1,2
1Canberra Orthopaedics and Sports Medicine; Canberra, ACT, Australia.
Summary
The Cross Bracing Protocol (CBP) for anterior cruciate ligament (ACL) rupture leads to significantly higher rates of recurrent instability and meniscal tears compared to surgical stabilization in pivoting sports athletes. This non-operative approach is not recommended for active individuals.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Biomechanics
Background:
- Anterior cruciate ligament (ACL) ruptures are common injuries in athletes participating in pivoting sports.
- Treatment options include surgical stabilization and non-operative protocols like the Cross Bracing Protocol (CBP).
- The optimal management strategy for ACL rupture in active individuals remains a subject of ongoing research.
Purpose of the Study:
- To compare the clinical outcomes of patients with ACL rupture treated with the Cross Bracing Protocol (CBP) versus surgical stabilization.
- To evaluate the incidence of recurrent instability and meniscal tears between the two treatment groups.
- To assess patient-reported outcome measures (PROMs) following CBP and surgical intervention.
Main Methods:
- An observational prospective cohort study with a 2-year follow-up was conducted.
- Eighty skeletally mature patients (16-40 years) with isolated ACL ruptures, intending to return to pivoting sports, were included.
- Patients were divided into two groups: Group A (40 patients) underwent surgical stabilization, and Group B (40 patients) followed the CBP.
Main Results:
- Group B (CBP) demonstrated a significantly higher risk of recurrent instability (70% vs. 2.5%, P < 0.001).
- The incidence of medial meniscal tears was substantially greater in Group B (62% vs. 2.5%, P < 0.001).
- All patient-reported outcome measures (PROMs) were significantly inferior in the CBP group compared to the surgical group (P < 0.001).
Conclusions:
- The Cross Bracing Protocol (CBP) is associated with an unacceptably high rate of recurrent instability and secondary injuries like meniscal tears.
- Surgical stabilization appears to yield superior clinical outcomes for anterior cruciate ligament ruptures in athletes engaged in pivoting sports.
- Non-operative management with CBP is not recommended for patients seeking return to high-demand pivoting activities following ACL rupture.
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