Researchers funded to explore a novel treatment for knee ligament rupture

Researchers from the Centre for Health, Exercise and Sports Medicine (CHESM) have recently been awarded $1.73 million in MRFF funding for a clinical trial that aims to explore a novel non-surgical treatment for anterior cruciate ligament rupture.

It has been assumed for decades that an anterior cruciate ligament (ACL) rupture has limited or no healing capacity. This has shaped current management, whereby most people in Australia with an ACL rupture undergo ACL reconstructive surgery.

This clinical trial builds upon two studies published in British Journal of Sports Medicine in 2023 led by A/Prof Stephanie Filbay. The first study found that 30% of people with acute ACL rupture who commence management with rehabilitation will experience a degree of ACL healing, as observed via MRI after two years. People with ACL healing reported better outcomes than those with no ACL healing on MRI, as well as having better outcomes than people managed with early ACL reconstruction. These findings suggest that ACL ruptures can heal, and that healing an ACL rupture may be related to favourable patient outcomes.

The second study described a novel non-surgical treatment, the Cross Bracing Protocol, which was designed to facilitate ACL healing. The Cross Bracing Protocol immobilises an ACL ruptured knee in a brace bent 90 degrees for 4 weeks (bringing ends of the ACL in close proximity to assist healing). At weekly increments the range of motion allowed within the brace is increased until the brace is removed at 12 weeks. This is combined with physiotherapist-supervised rehabilitation. In the first 80 people with ACL rupture managed with this novel treatment, 90% had signs of ACL healing on 3 month MRI. An appearance of the ACL on MRI that was closer to normal was associated with better clinical outcomes, which were excellent in people with a high degree of ACL healing.

A/Prof Stephanie Filbay and her team have recently been awarded $1,725,343 in funding from the MRFF to perform a multi-site comparative effectiveness trial comparing patient outcomes and treatment costs between two ACL rupture treatments: the novel Cross Bracing Protocol compared to early ACL surgery. The Cross Bracing Protocol has already received global interest from consumers, health providers, media, professional bodies and policy makers but needs more rigorous evidence to compare outcomes to the most common treatment approach, ACL reconstruction. The multidisciplinary research team includes (from left to right in the image below) A/Prof Stephanie Filbay, Prof Kim Bennell, Prof David Hunter, Prof Ian Harris, Prof Nadine Foster, Prof Rana Hinman, Dr Adam Culvenor, A/Prof An Tran-Duy, Dr Anurika De Silva, A/Prof Jane Rooney and Dr Tom Cross. The clinical trial is supported by key stakeholders who will assist with rapid translation of the intervention into clinical practice if shown to be beneficial.

Grant team