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

Anterior cruciate ligament (ACL) injuries are traditionally managed with surgical reconstruction, but the ACL's healing capacity continues to be explored. Non-operative management strategies have emerged as viable alternatives for ACL-injured patients either via rehabilitation alone or approaches like the Cross-Bracing Protocol (CBP). We report the case of a female Australian rules football (AFL) athlete with a complete ACL rupture sustained through a non-contact hyperextension mechanism. The athlete was treated with the 12-week CBP, and the serial MRI examinations at 3-, 6-, 12-, and 36-month post-injury are presented, demonstrating progression from a complete ACL rupture to a contiguous ACL with normal thickness, volume, trajectory, and signal intensity. Patient-reported outcome measures (PROMS) were collected at 3-, 6-, 12-, and 36-month post-injury. The athlete successfully returned to elite-level AFL sport one year post-injury and reported no re-rupture at 3 years post-injury. This case demonstrates the potential utility of the CBP to restore normal ACL anatomy and result in stability of the knee following non-surgical management.