ACL Healing

MRI images showing ACL continuity with arrows indicating the ligament

Non-Surgical ACL Healing

Research has shown that some complete ACL ruptures can demonstrate healing on follow-up MRI following non-surgical management. At Athletica Sports Physio & Performance, we provide individualised ACL assessment, bracing and rehabilitation, with Block Knee Extension Bracing (BLEX) used as the primary bracing approach where clinically appropriate.

Suitability is assessed using the injury pattern, MRI findings, timing of assessment, associated injuries and the individual’s goals. Bracing is combined with structured rehabilitation to progressively restore movement, strength, stability and function, and support return to activity and sport where appropriate.

Block Knee Extension Bracing (BLEX)

Block Knee Extension Bracing (BLEX) uses a hinged knee brace with extension limited to 30° and flexion allowed to 120° during the first six weeks. This positioning aims to bring the torn ACL ends into closer approximation and support the potential for healing.

During the final six weeks, the brace is adjusted to allow full knee range of motion. Rehabilitation continues throughout the bracing period and includes progressive strength training, balance and proprioception exercises, and other functional rehabilitation according to the individual’s presentation.

Cross Bracing Protocol

The Cross Bracing Protocol is a separate non-surgical ACL management approach and is only commenced in selected referred cases following medical approval. Suitability depends on the individual injury pattern, MRI findings, associated injuries and clinical presentation.

Surgical and Non-Surgical ACL Treatment

ACL treatment decisions are individualised. Some people may be suitable for non-surgical management, while others may be better suited to ACL reconstruction. Factors such as associated injuries, knee stability, sporting demands, individual goals and preferences are considered when deciding on the most appropriate pathway.

Factors That Influence Treatment Decisions

Early MRI can provide useful information about the ACL’s healing potential. Features considered include the integrity of the ligament’s attachments, tear location, the distance between the torn ends and whether the torn fibres have retracted into rounded stumps. ACL tears with preserved attachment integrity, a smaller gap and minimal retraction are considered more favourable for healing. These MRI features are considered alongside knee function, associated injuries and the individual’s goals when planning treatment.

The Importance of Rehabilitation

Structured rehabilitation is an important part of non-surgical ACL healing and management. Early rehabilitation focuses on restoring knee movement, reducing swelling and progressively rebuilding strength, balance and control. Appropriate loading also provides mechanical stimulus to the healing ligament, which may support tissue remodelling during the healing process.

Rehabilitation then progresses through strength development, running, jumping and landing. Change-of-direction, reactive and sport-specific training is introduced later and guided by ACL healing on follow-up MRI, knee stability, physical testing, symptoms and sporting demands.

Access to a fully equipped gym allows rehabilitation to progress from early injury management through to higher-level Strength & Conditioning and return-to-sport preparation.

Returning to Pivoting Sports

Return to pivoting sport following non-surgical ACL management is individualised and guided by ACL healing, knee stability, the individual's goals, strength, movement control and sport-specific demands.

At approximately 12 weeks, following the initial knee bracing period, we use follow-up MRI to assess and grade ACL healing. MRI findings help guide decisions around progression to pivoting sport, together with clinical and functional testing.

ACL healing may be less critical for some people whose goals are limited to straight-line running or lower-demand pivoting activities, provided the knee remains stable and symptoms are well controlled.

Summary: Non-Surgical ACL Healing and Management

Non-surgical ACL healing and management is an option for selected ACL injuries. At Athletica Sports Physio, Block Knee Extension Bracing (BLEX) is the primary bracing approach where clinically appropriate, combined with structured rehabilitation and progressive return-to-sport preparation.

We review your MRI, clinical presentation and goals to determine the most appropriate approach for your ACL treatment and discuss the factors that influence ACL healing potential.

Appointments are available in person in Adelaide and through Telehealth worldwide.

Book An Initial Consult

References

Diermeier, T., Rothrauff, B.B., Engebretsen, L. et al. (2020) ‘Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group’, Knee Surgery, Sports Traumatology, Arthroscopy, 28(8), pp. 2390–2402. doi:10.1007/s00167-020-06012-6.

Filbay, S.R., Dowsett, M., Chaker Jomaa, M. et al. (2023a) ‘Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol’, British Journal of Sports Medicine, 57(23), pp. 1490–1497. doi:10.1136/bjsports-2023-106931.

Filbay, S.R., Roemer, F.W., Lohmander, L.S. et al. (2023b) ‘Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial’, British Journal of Sports Medicine, 57(2), pp. 91–98. doi:10.1136/bjsports-2022-105473.

Filbay, S.R., Dowsett, M., van Haeringen, M. et al. (2026) ‘A new way of grading severity of ACL rupture on acute MRI to consider potential for non-surgical healing with the Cross Bracing Protocol’, Journal of Science and Medicine in Sport, 29(2), pp. 145–148. doi:10.1016/j.jsams.2025.08.017.

Fujimoto, E., Sumen, Y., Ochi, M. and Ikuta, Y. (2002) ‘Spontaneous healing of acute anterior cruciate ligament injuries: conservative treatment using an extension block soft brace without anterior stabilisation’, Archives of Orthopaedic and Trauma Surgery, 122(4), pp. 212–216. doi:10.1007/s00402-001-0387-y.

Meredith, S.J., Rauer, T., Chmielewski, T.L. et al. (2020) ‘Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group’, Knee Surgery, Sports Traumatology, Arthroscopy, 28(8), pp. 2403–2414. doi:10.1007/s00167-020-06009-1.

van Melick, N., van Cingel, R.E.H., Brooijmans, F. et al. (2016) ‘Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus’, British Journal of Sports Medicine, 50(24), pp. 1506–1515. doi:10.1136/bjsports-2015-095898.