How a revolutionary new treatment is helping some patients heal ACL tears without surgery
Every year, millions of people Anterior cruciate ligaments (ACL) are torn or sprained all over the world. The most common knee injury usually occurs when people ski, play football, basketball or netball.
According to Keiley Mead, it was a pothole that did it.
The 24-year-old was playing Oz Tag at his local football field in Sydney’s Sutherland Shire when he stepped into a large chute in the grass. He felt a shock of pain and an “explosion” as his knee slipped in the wrong direction and his leg broke.
Playing elite AFL at the time, Mead had witnessed many of his teammates tear their ACL (injury up to eight times (more common in women). After the surgery, he knew it didn’t have to be a career-ending injury. 65 percent Most people return to their previous levels, but that meant having surgery and staying away from sports for at least a year.
Mead had already booked surgery when a friend suggested she speak to sports doctor and former Sydney Swans doctor Tom Cross.
“My friend said: ‘Look, I don’t know if this will help, but go chat with this guy.'”
Eight years ago, Cross was treating a 19-year-old who had torn her anterior cruciate ligament while playing netball. The standard treatment was surgery, but the woman pressed Cross for another option because her close friends were once again in tears after the surgery (between 8 and 30 percent Proportion of people who re-rupture after surgery).
Cross’s father, Merv, a retired orthopedic knee surgeon, was being treated at the clinic for a knee injury. Merv overheard the conversation and opened the curtain with an idea that came to his mind.
Merv suggested that by bending the knee 90 degrees and immobilizing it with a brace, you can bring the torn ends of the ACL closer together, allowing them to heal similar to a bone fracture.
Tom thought this was a bit crazy; no one ever raised their knee above 30 degrees when trying to heal a wound He had a knee ligament injury but he trusted Merv pioneer knee surgeon With 40 years of experience, he also served as director of orthopedics at the Sydney 2000 Olympics.
The patient thought he had nothing to lose. If it doesn’t work, he may still have surgery. So they put him in a brace, locking his knee at a right angle for four weeks. Over the next two months they gradually straightened the leg and gradually put more weight on it. Three months after this crazy experiment, MRIs revealed a “euphoric recovery.”
With more than 1,450 patients and a 90 percent success rate, the cross-bracing protocol, known as the cross-bracing protocol (CBP),revolutionary”A new approach to the treatment of ACL tears.
Cross explains that when people say they’ve torn their ACL, it’s not a binary situation.
“ACLs are injured on a spectrum,” he says. “Some may have less damage to their ACL, while others may have been seriously injured.”
Some heal on their own without support, some need help bending the knee and putting the tissue back together, and some definitely need a surgeon.
Expert opinion is that up to 40 percent of people with ACL injuries may be good candidates for CBP, depending on MRI and evaluation.
“It’s a pretty big paradigm shift because for decades in Australia if people tear their ACL they immediately think, ‘I need reconstruction’.”
Initial MRIs suggested Mead was a good candidate for CBP.
“It’s definitely difficult to get the protocol started,” he says. “You are not very mobile because your leg is bent 90 degrees [degrees] “I was always getting around on crutches or a wheelchair.”
She also continued to hit the gym for upper-body work and single-leg exercises: “I made it work.”
Three months later, scans showed that his anterior cruciate ligament had reattached and his leg felt solid enough to move. After nine months, he had passed his return to exercise tests as well as physiotherapy. He was back playing in the AFL premier league within 14 months and entered the Sydney Swans reserve programme.
Four years later he moved on to triathlons and the trained radiologist earned his doctorate investigating how MRI assessments of anterior cruciate ligament injuries could be improved to optimize treatment.
Cross predicts that within five years, it will get to the point where an MRI combined with a deep learning AI model will reveal tear type, healing propensity, and whether a cross-boost protocol will improve outcome.
Associate senior research fellow at La Trobe University, Dr. Marc-Olivier Dubé says this is a “promising intervention”.
Avoiding surgery eliminates the risk of adverse events such as infection, blood clots, pain and numbness at the graft site. It is also significantly more cost-effective.
A new review article co-authored by Dube points out: half of everyone People who tear their anterior cruciate ligaments develop osteoarthritis within 10 years, regardless of the treatment option. But up to 50 percent report that through progressive rehabilitation alone, they can avoid surgery altogether and have similar results to those who do undergo surgery.
As for CBP, he says: “The jury is still out and we need a lot more evidence.”
Adam Culvenor, head of the Knee Injury Research Group at La Trobe Sports and Exercise Medicine Research Centre, agrees.
Says there are multiple randomized controlled trials Ongoing studies worldwide will shed important light on whether the cross-support protocol is more effective than ACL reconstruction surgery or brace-free nonsurgical care.
While the research is slowly progressing, Mead says its outcome is “wonderful.”
“I haven’t had any problems with my knee since then,” he says. “It feels stable, it feels good, I’m very happy with it.”
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Sarah Berry is a lifestyle and health writer for The Sydney Morning Herald and The Age.Connect with: X or email.
