Cross-Bracing and Non-Operative ACL Management with Jane Rooney – Episode Summary

In this episode, Associate Professor Jane Rooney shares groundbreaking insights into non-operative management of ACL injuries, based on years of clinical experience, research leadership, and findings from her Churchill Fellowship.

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Jane begins by highlighting the international differences in ACL injury management (4:10), noting Australia’s alarmingly high ACL surgical rate compared to countries like Sweden and the Netherlands. Through her Fellowship, she explored how surgery, rehabilitation, and health system structures impact patient outcomes and healthcare costs.

At 7:16, Jane discusses the development of a patient decision aid to support informed, individualized decision-making between operative and non-operative management. Drawing from large surveys of patients and physiotherapists, Jane emphasizes the need for true shared decision-making, free from clinician bias.

Through a case study (10:15), Jane illustrates how surgical decisions must be based on a patient's unique goals, health circumstances, and sport demands — not a one-size-fits-all approach.

Jane then introduces the Cross-Bracing Protocol (15:45), explaining its origins from both spontaneous ACL healing observations and clinical experimentation. She describes how immobilizing the knee at 90 degrees can assist natural ACL healing by shortening ligament ends (25:30). This contrasts traditional views that the ACL cannot heal.

However, bracing isn't suitable for everyone (23:19). Jane warns that patient selection is critical, as inappropriate bracing carries risks — including serious medical complications if not medically supervised (30:30). She stresses that cross-bracing must involve a collaborative team of a physician, surgeon, and physiotherapist.

Eligibility criteria for bracing include timing (ideally within 16 days post-injury), tear type, and patient factors like lifestyle and medical history (33:36). Jane also explains the anatomy of ACL healing and how MRI findings (especially displacement and femoral footprint integrity) influence bracing success (37:05).

At 41:45, Jane outlines the risks of inappropriate referrals and the importance of early and accurate diagnosis. She shares that while early case series show a 90% ACL healing rate and a lower re-injury risk compared to surgery, cross-bracing is still evolving and requires cautious optimism.

Finally, Jane looks ahead (47:30, 59:50), imagining a future where non-operative bracing becomes a mainstream option, alongside surgery and rehab-alone strategies. She emphasizes that shared decision-making — balancing risks, benefits, and individual goals — will remain at the heart of best practice ACL care.

This conversation is a must-listen for anyone interested in the future of ACL management, patient-centered care, and physiotherapy-led innovation.

Thanks to Jane for a great conversation

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