Cross Bracing Protocol Reports 90% Success Rate for Select ACL Tears, but RCTs Underway to Compare With Surgery

Keiley Mead, 24, tore her ACL when she stepped into a large divot while playing Oz Tag on a field in Sydney’s Sutherland Shire. She felt a shock of pain and a pop as her knee slid out of alignment and her leg gave way. At the time she was playing elite AFL and had already scheduled reconstructive surgery.

A friend referred her to sports physician Tom Cross, whose father, retired orthopedic surgeon Merv Cross, had proposed an alternative eight years earlier. Merv Cross suggested bending the knee to 90 degrees and locking it in a brace to bring the torn ligament ends together.

The first patient treated with the method kept her knee braced at that angle for four weeks, then gradually straightened the leg over the next two months while increasing weight-bearing.

Three months after the injury, MRI scans of that first patient showed exuberant healing. The protocol has since been used on more than 1,450 patients and carries a reported 90 percent success rate. Tom Cross said ACL injuries occur on a spectrum and estimated that up to 40 percent of patients could be suitable for the approach depending on MRI findings and clinical assessment.

Mead began the protocol after initial scans indicated she was a candidate. She remained non-weight-bearing with her knee fixed at 90 degrees, using crutches or a wheelchair, while continuing upper-body and single-leg gym work. Three months later, scans confirmed the ligament had reattached and her knee felt stable.

By nine months she had passed return-to-exercise tests alongside physiotherapy. Within 14 months of the injury she returned to premier-division AFL and joined the Sydney Swans reserve program. Four years later she has switched to triathlons and completed a PhD focused on improving MRI assessment of ACL injuries.