The ACL has the capacity to heal. For the right injury, caught in the right window, a braced knee and a structured rehab plan can restore the ligament without reconstruction.
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Time-critical — act within days, not weeks An acute ACL tear should be treated like a fresh wound. The window to begin the Cross Bracing Protocol is 4–10 days after injury, and the protocol is generally not recommended beyond 21 days. If you have torn your ACL in the last three weeks, get assessed now.
The ideal window to start bracing after an acute ACL injury.
Of patients showed MRI-confirmed ACL healing at three months in published studies.
Patients have completed the Cross Bracing Protocol since the original 2023 study.
In brace, followed by a criteria-based return to sport at 9–12 months.
For decades the anterior cruciate ligament was treated as a structure that could not repair itself, and reconstruction was the default answer to a complete tear. That assumption is being revised.
Under the right conditions — the right tear pattern, the right timing, and the ligament ends held in close approximation — the ACL can heal. The Cross Bracing Protocol is built to create those conditions deliberately rather than leave them to chance.
It is not a replacement for surgery in every case. Roughly half of ACL ruptures are too severe for meaningful healing, and those athletes are better served by reconstruction. The job of the assessment is to tell those two groups apart early.
Three broad pathways exist after a complete ACL tear. Which one fits depends on your MRI, how long ago the injury happened, and what you need your knee to do afterwards.
The ligament is replaced with a graft. Well-established, widely available, and the appropriate choice for severe tears, multi-ligament injury and many high-demand athletes. Involves surgery, a graft donor site, and a long rehabilitation.
Structured physiotherapy without surgery or bracing. Some tears do heal this way, and many people function well without an intact ACL. Healing of the ligament itself is less predictable, and instability can persist in cutting and pivoting sports.
A brace holds the knee in flexion so the torn ligament ends sit close together while they heal, alongside supervised rehabilitation. Time-sensitive and not suitable for every tear — but where it fits, it can restore the native ACL without an operation.
The Cross Bracing Protocol (CBP) is a non-surgical approach to managing acute ACL injuries, developed by Dr. Mervyn Cross and Dr. Tom Cross in Australia. Grounded in knee anatomy, joint biomechanics and ligament healing physiology, it aims to support natural healing of the ACL through strategic bracing and rehabilitation.
Contrary to traditional belief, the anterior cruciate ligament has the potential to heal — under the right conditions.
Research from the ACL-HEAL team suggests approximately 50% of ACL ruptures are too severe for meaningful healing. Those cases may still require surgery, especially for athletes returning to high-demand sport.
An acute ACL injury should be treated like a fresh wound. The ideal window of opportunity for starting the protocol is 4–10 days post-injury.
Partial tears and full ruptures without major displacement of ligament tissue may heal successfully with structured bracing and rehabilitation.
The protocol applies the orthopaedic principle of reduction — using a brace to hold the knee in flexion, which approximates the torn ligament ends and promotes tissue healing.
After roughly 8–14 days, involution of the torn ACL tissue may begin, significantly reducing the chance of successful healing. The protocol is generally not recommended beyond 21 days post-injury, though rare later cases have healed.
The initial study of 80 patients was published in the British Journal of Sports Medicine in 2023. Since then, over 580 patients have undertaken the Cross Bracing Protocol, with ongoing research continuing to shape its application.
Below is an example of the 12-week protocol. Select a stage to see the permitted range of motion and weight-bearing status at that point.
The brace is locked and worn continuously to hold the torn ligament ends in approximation.
Anticoagulation and calf-pump work run through Week 8 to manage DVT risk.
The bracing schedule is matched to the tear pattern, the MRI findings and how quickly you present. Your medical team will confirm which schedule applies to you at assessment.
The standard schedule: four weeks locked at 90°, then staged unlocking through Week 12.
A shortened schedule used for selected tear patterns.
The shortest bracing schedule offered.
A blended schedule combining bracing with an adapted rehabilitation plan.
At ØRKA Performance we have developed a five-stage rehabilitation pathway that keeps you on track at every point. Each block targets the key performance indicators found in your testing, so progression is earned rather than assumed.
The knee is locked at 90° flexion in a ROM brace worn 24/7 to protect ACL approximation and optimise intrinsic healing. You remain non-weight bearing using crutches or a scooter. Physiotherapy focuses on minimising atrophy and swelling while avoiding NSAIDs and aspiration. Weekly sessions include manual therapy at 90°, quadriceps and hamstring co-contractions, hip abduction and extension, and calf Theraband plantarflexion. The other limb is strengthened with presses, curls, bridges and core work, while upper body strength, airdyne and ski erg conditioning preserve global fitness. DVT mitigation runs through Week 8 with calf pumps and blood thinners.
Brace unlocking is progressive: 60°–90° at Week 5, 45°–90° at Week 6, 30° to full flexion at Week 7, and unrestricted by Week 10 if tolerated. Partial weight bearing begins in Week 7 and advances to full weight bearing as tolerated by Week 8. Anticoagulation ceases at the end of Week 8. Physiotherapy introduces dynamic range of motion drills, wall squats (starting at 45°, then 30°), bodyweight squats within brace limits, bridges, monster walks, leg press and heel slides. Gait retraining begins alongside static balance work and exercise bike use once flexion exceeds 100°. MRI and medical reassessment occur at Week 12 with the ØRKA Sports Medicine team and community partners.
Following brace removal in Week 13, maximal strength and force production work intensifies under full weight-bearing conditions. Physiotherapy progresses hamstring and quadriceps strength with machines and functional movements — single-leg squats, Bulgarian split squats, half-range lunges and dynamic balance. Calf raises, single-leg press and hamstring curls are added, along with jogging in place, skipping and cardio equipment for reconditioning. Athletes must meet the ØRKA Return-to-Run criteria before straight-line running begins around Weeks 15–16. Manual therapy continues and functional movement analysis is used to assess running readiness as you enter ØRKA’s Return to Run program.
This phase reintroduces high-velocity and reactive elements in preparation for sport, including power development. You move from closed, controlled environments into variable and reactive settings. With the brace no longer required, progression runs through structured exposures — deceleration and controlled linear mechanics first, then unanticipated tasks such as reactive cuts, agility sequences and jump-landing variability. Emphasis sits on rate of force development under unpredictable conditions, reactivity to auditory and visual cues, and perceptual-cognitive demands like pattern recognition and anticipation. Physiotherapy includes multidirectional drills, single-leg landings under fatigue, decel-reaccel tasks and dual-task constraints such as passing and catching during movement.
The culmination of the journey. This stage prepares you for full integration into high-speed, high-load, high-context environments. Clearance is based on robust return-to-sport criteria alongside demonstrated resilience in chaos-based drills. The focus shifts from physical readiness to return to performance — decision-making, skill execution under fatigue and position-specific chaos. Integrated field sessions replicate real match tempo and intensity, layering in opposition pressure, time constraints and reactive transitions. Load monitoring, neuromuscular testing and communication with your sport coaches guide return-to-play progressions. You are not just cleared to participate — you are prepared to perform at pre-injury levels or better. Return to sport is criteria-based, typically falling between 9 and 12 months post-injury where there are no complications.
Cross bracing only works when everyone around the knee is coordinated — physician, radiologist, surgeon, physiotherapist, strength coach, and the athlete and family carrying the twelve weeks.
Cross bracing carries costs that a surgical pathway does not — the brace itself, extended physiotherapy, imaging outside publicly funded pathways, mobility aids and medication. We publish the range up front so you can plan rather than be surprised.
Many of these items are wholly or partly covered by extended health benefit plans such as Blue Cross, Sun Life, Manulife or Green Shield. Our administrative team will help you understand what your plan covers before you commit.
Developed by Dr. Tom Cross, Sports and Exercise Medicine Physician. For more information, visit healACL.com.
This page is based on the principles of the Cross Bracing Protocol™, a trademarked approach by Dr. Tom Cross. All rights to the original protocol, including associated resources and infographics, remain with the original creator. This adaptation is for informational purposes within the Canadian context and does not constitute medical advice. Suitability for the protocol can only be determined by a qualified medical assessment.
If you tore your ACL in the last three weeks, an assessment costs you nothing but tells you whether this pathway is even possible. After that, the option closes.
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