The Cross Bracing Protocol - Online Lecture

Online Introduction to the Cross Bracing Protocol (CBP)

In this introductory online lecture, Associate Professor Jane Rooney will share insights into the non-operative management of ACL injuries, drawing on years of clinical experience and recent research evidence on the Cross Bracing Protocol (CBP).

Jane will discuss the international differences in ACL injury management and explore how surgery, rehabilitation, and healthcare system structures influence patient outcomes and healthcare costs.

She will introduce the Cross Bracing Protocol, explaining its origins in both spontaneous ACL healing observations and clinical experimentation. Jane will outline how immobilising the knee at 90° flexion may promote natural ACL healing by shortening ligament ends—a concept that challenges the traditional belief that the ACL cannot heal.

Jane will also explain that bracing is not suitable for everyone and must always be carried out under medical supervision, with input from a collaborative team of physician, surgeon, and physiotherapist

Please note: This session serves as an introduction to the Cross Bracing Protocol. For those wanting practical training, it links to the in-person workshop taking place on 15–16 November 2025, covering acute knee assessment, brace fitting, rehabilitation through the protocol stages, and contemporary ACL rehabilitation strategies from brace removal through to return-to-sport.

Associate Professor Jane Rooney, FACP is a Specialist Sports and Exercise Physiotherapist (subspecialty knee) (as awarded by the Australian College of Physiotherapists in 2009)  and a Titled Musculoskeletal Physiotherapist.  

Jane has a particular interest in ACL injury management. She was awarded a prestigious Churchill Fellowship in 2016 to investigate management algorithms and non-operative management strategies for ACL injury, travelling to Europe, Scandinavia and America. This inspired a research project conducted with Dr Stephanie Filbay and team examining treatment decision making for ACL rupture from the perspective of physiotherapists and patients in Australia, in Print in Physical Therapy. The results informed a free online patient decision aid for shared decision-making following ACL injury.

 Jane has been implementing the Cross Bracing protocol since 2019 and is a co-author of the published Cross Bracing case series in BSJM, 2023. She is also a co-author and the rehab protocol designer for both arms of the forthcoming multicenter RCT comparing Cross Bracing to ACL reconstruction for ACL injury management. 

Jane works as a clinician at Prahran Sports Medicine Centre, a large multi-disciplinary sports clinic, collaborating closely with many of Melbourne’s leading knee surgeons and sports physicians. working with athletes of all abilities from recreational to professional.

Online Zoom Session – Outline

1. Introduction

• Welcome and session overview
• Current beliefs about ACL rupture healing capacity
• International differences in ACL injury management

2. ACL Healing Science

• Anatomy and vascular supply of the ACL
• Histological evidence of healing potential
• Barriers to healing: the “gap problem”
• Role of MRI in assessing healing potential

3. The Cross Bracing Protocol (CBP)

• Origins and development of CBP
• Rationale: reducing ligament gap distance by immobilising knee at 90° flexion
• Protocol stages: immobilisation → progressive ROM → structured rehabilitation

4. Clinical Application

• Eligibility criteria for bracing (timing, tear type, patient factors)
• Importance of multidisciplinary care (physician, surgeon, physiotherapist)
• Case examples and outcome data

5. Key Considerations

• Who CBP is and isn’t suitable for
• Risks, limitations, and patient compliance factors
• Practical implications for healthcare systems

6. Next Steps

• How this introduction links to the Face-to-Face Workshop (15–16 November 2025)
• Workshop content: acute knee assessment, brace fitting, shared decision-making, rehabilitation progressions, return-to-sport strategies

7. Q&A Session