Cross Bracing: Why I Don't Currently Recommend It

Cross Bracing: Why I Don't Currently Recommend It

Let me start with my bottom line, since you deserve that upfront rather than buried at the end of a long article: I don't currently recommend the Cross Bracing Protocol (CBP) to my patients. Not because the idea is silly — it isn't — but because the early results are genuinely mixed, the burden it places on you day-to-day is significant, and the one study that's actually compared it head-to-head against surgery found it wanting. Everything below is so you understand exactly why I've landed there, and so you can ask me informed questions if you come across it online.

Where the Name Actually Comes From

If you've assumed "Cross Bracing" describes the shape of the brace or a crossed-leg position, you're not alone — but that's not it. The protocol is named after its founders: Dr Mervyn Cross, an Australian orthopaedic surgeon, and his son, Dr Tom Cross, a sports and exercise medicine physician, both based at a Sydney clinic. Mervyn Cross's interest in the ACL goes back to anatomical studies he conducted in the 1970s; decades later, in 2014, the two of them braced their first patient — a 19-year-old netballer — with the theory that immobilising the knee at 90 degrees would hold the torn ends of the ACL close enough together to heal. What started as an idea tried on a handful of patients has since grown into a structured protocol with its own research program.

What the Protocol Actually Involves

The core idea is straightforward: the knee is locked at 90 degrees of flexion in a brace, non-weight-bearing on crutches or a mobility aid, for the first 4 weeks. From week 5, the brace is gradually opened in stages — typically to 60, then 45, then 30, then 20, then 10 degrees over successive weeks — until it's removed entirely around week 12. Throughout, patients attend structured physiotherapy, and the ACL's healing progress is checked with MRI, usually at 3 and 6 months.

Not everyone is a candidate. Based on the protocol's own published eligibility criteria, only around 30% of people with an acute ACL rupture are considered suitable, based on a combination of patient factors and specific MRI findings — things like how close the torn ends of the ligament sit to each other, how much tissue has displaced outside its normal position, and how quickly you can get braced after injury (the ideal window is 4 to 10 days)⁴. People with a displaced bucket-handle meniscus tear, other structural injuries needing surgery, or a history of blood clots are excluded outright.

What Daily Life on the Protocol Actually Looks Like

This is worth being honest about, because it's a real commitment, not just a brace you wear and forget about.

For the first 4 weeks, you're non-weight-bearing and using crutches or a mobility aid — options include a knee scooter, an iWalker, or a wheelchair, and some patients use a "Kneerover"-style scooter. You'll need to relearn basic things: how to manage stairs on crutches (non-injured leg leads going up, crutches lead going down), how to shower with the brace on (either covered to keep it dry, or removed while seated on a stool), and how to sleep with your knee locked at 90 degrees — most patients find lying on their back with pillows under the knee, on their side with a pillow between the knees, or on their stomach with a pillow under the shin most workable. Hamstring and calf cramping is common and is usually managed with massage and staying within the prescribed angle⁵.

Skin care matters too — a poorly fitted or damp brace increases the risk of skin breakdown, so proper fitting and regular adjustment are part of routine care. And falls risk is a genuine safety issue, particularly in weeks 9 to 12 when the knee is still stiff and weak but you're bearing more weight: patients on the protocol are typically prescribed a blood thinner (to manage clot risk from the period of immobilisation), which also means a fall carries a higher bleeding risk than it otherwise would⁵. None of this is meant to frighten you — it's meant to be honest that this is a genuinely demanding 12 weeks, not a passive treatment you do alongside normal life.

What the Evidence Actually Shows — Both Sides

I covered part of this in the risks article, but it's worth laying out fully here, because the two major studies on this protocol point in somewhat different directions.

The protocol's own case series, published by the team that developed it, found that 90% of patients had MRI evidence of a healed, continuous ACL at 3 months, and those with the best healing grade had a 92% return-to-sport rate, less knee laxity, and better function than those with poorer healing¹. That's a genuinely striking result. But the same study reported that 14% of patients re-ruptured their ACL within the following year — including some patients whose ACL had looked well-healed on their 3-month MRI¹. A good-looking scan didn't guarantee the ligament would hold up under real sporting loads.

Then, separately, a 2-year controlled cohort study directly compared patients managed with the Cross Bracing Protocol against patients who had surgical stabilisation, specifically looking at return to pivoting sports. It found the protocol carried an unacceptably high rate of recurrent instability compared with surgery². This is the study that most changes my thinking: a favourable case series from the team that invented a treatment is a reasonable first step, but it's exactly the kind of result that needs to hold up in an independent, comparative study — and so far, in the one study built to make that comparison, it hasn't.

Why I Don't Currently Recommend It

Putting this together, here's my honest reasoning:

• The comparative evidence, where it exists, isn't favourable. A single-arm case series showing good MRI healing is encouraging, but it isn't the same as knowing how those patients would have done with surgery instead. The one study that made that direct comparison found the protocol coming up short on instability².
• We still don't know if a "healed" ACL functions like a normal one. As covered in the MRI-healing article, a continuous ligament on a scan doesn't necessarily mean restored mechanical stability — and the CBP's own 14% re-rupture rate, even among well-healed patients, is consistent with that uncertainty¹.
• The burden is real and the eligible window is narrow. Only around 30% of patients even qualify based on strict imaging criteria, and those who do face 12 weeks of a genuinely demanding, immobilising process with its own risks (skin breakdown, falls, and the bleeding risk that comes with the blood thinners used during it).
• This is still, honestly, an experimental protocol. It's promising enough to study properly — which is exactly what's now happening — but promising early data from the inventors of a technique is a different category of evidence to a completed, independent randomised trial.

What Would Change My Mind

There's now a proper answer coming. The EMBRACE trial (registered as NCT06956339) is a randomised controlled trial directly comparing the Cross Bracing Protocol against early ACL reconstruction surgery, running across five Australian cities with 180 participants, led by researchers including A/Prof Stephanie Filbay at the University of Melbourne³. This is the actual head-to-head comparison the evidence has been missing, funded by an Australian government medical research grant. It's expected to report around 2030.

Until a trial like this reports, I think it's honest to treat the Cross Bracing Protocol as a research protocol worth watching closely, not a mainstream treatment I can confidently offer you. If the EMBRACE trial shows it holds up against surgery, that would genuinely change my recommendation. Until then, my view stands: interesting, worth following, not something I currently recommend.

Where to Go From Here

This page was a deeper dive into a specific approach mentioned in the risks article. If you haven't read that one yet, or want the fuller picture of what non-operative management involves more generally, start with [The Risks of Non-Operative ACL Management].

References

1. Filbay SR, Dowsett M, Chaker Jomaa M, et al. Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Br J Sports Med. 2023;57:1490-1497.
2. Porter MD, Shadbolt B. Cross Bracing Protocol for Anterior Cruciate Ligament (ACL) Rupture Has Unacceptably High Failure Rate Relative to Surgical Stabilization: A 2-year Controlled Cohort Study. Clin J Sport Med. 2026 Feb 2. doi: 10.1097/JSM.0000000000001416. PMID: 41622530.
3. Cross Bracing Protocol Versus Surgery for Acute Anterior Cruciate Ligament Rupture (EMBRACE). ClinicalTrials.gov identifier NCT06956339. Available at: https://clinicaltrials.gov/study/NCT06956339
4. Cross Bracing Protocol™. Patient Information. Available at: https://crossbracingprotocol.com/patient-information
5. Cross Bracing Protocol™. Patient Information Booklet, Version 1.2. 2025.