Non-Operative Management of a Complete ACL Rupture With the Cross-Bracing Protocol in an Elite Australian Rules...

Area of Science:

• Orthopedics
• Sports Medicine
• Regenerative Medicine

Background:

• Anterior cruciate ligament (ACL) injuries often require surgical reconstruction.
• Non-operative management, including rehabilitation and novel protocols, is increasingly explored for ACL injuries.
• The healing potential of the ACL itself remains an area of active investigation.

Purpose of the Study:

• To report a case of a complete ACL rupture managed non-operatively using the Cross-Bracing Protocol (CBP).
• To assess the anatomical healing of the ACL via serial MRI.
• To evaluate patient outcomes and return to sport following CBP treatment.

Main Methods:

• A female Australian rules football (AFL) athlete with a complete ACL rupture was treated with a 12-week CBP.
• Serial MRI examinations were performed at 3, 6, 12, and 36 months post-injury.
• Patient-reported outcome measures (PROMs) were collected concurrently with MRI assessments.

Main Results:

• Serial MRIs demonstrated progression from a complete ACL rupture to a contiguous ACL with normal anatomical characteristics (thickness, volume, trajectory, signal intensity).
• The athlete successfully returned to elite-level AFL competition one year post-injury.
• No re-rupture was reported at the 3-year follow-up.

Conclusions:

• The Cross-Bracing Protocol (CBP) shows potential for non-operative management of complete ACL ruptures.
• CBP may facilitate the restoration of normal ACL anatomy and knee stability.
• This case highlights the possibility of returning to elite sport after non-surgical ACL healing.