Cross Bracing Protocol for Anterior Cruciate Ligament (ACL) Rupture Has Unacceptably High Failure Rate Relative to Surgical Stabilization: A 2-year Controlled Cohort Study

OBJECTIVE: To compare the clinical outcome of patients electing to undergo the Cross Bracing Protocol (CBP) for ACL rupture with those choosing surgical stabilization. DESIGN: Observational prospective cohort study with 2-year follow-up. SETTING: Private subspecialist sports orthopedics and sports medicine practice. PATIENTS: The 80 patients who both entered and completed the study were skeletally mature 16 to 40 years old, presenting with an acute noncontact isolated ACL rupture, taking part in pivoting sports and intent on returning to that activity. ACL rupture was diagnosed on both clinical assessment and MRI. Patients were fit for general anesthetic and free of significant medical conditions. INTERVENTIONS: Group A (40 patients) underwent surgical stabilization, and group B (40 patients) followed the CBP. The groups were similar regarding the following independent variables: age, body mass index, gender, dominance of the injured knee, and posterior tibial slope ( P > 0.05). MAIN OUTCOME MEASURES: Recurrent instability, incidence of meniscal tears, and the following patient-reported outcome measures (PROMs); Tegner Activity Scores; Knee Injury Osteoarthritis Outcome Score subscales of sport/recreation and knee-related quality of life; subjective International Knee Documentation Committee score; and Lysholm Knee Score. RESULTS: Group B had significantly higher risk of recurrent instability (70% vs 2.5%, P < 0.001), medial meniscal tear (62% vs 2.5%, P < 0.001), and inferior performance on all PROMs ( P < 0.001). CONCLUSIONS: The CBP is associated with an unacceptably high rate of recurrent instability when used to treat ACL ruptures in patients taking part in pivoting sports.